How Should We Manage Adverse Intradialytic Blood Pressure Changes?

Santos, Sérgio F.; Peixoto, Aldo J.; Perazella, Mark A.

doi:10.1053/j.ackd.2012.03.003

Cited by 32 publications

(20 citation statements)

References 64 publications

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“…Intradialytic hypotension is a common complication in dialysis, occurring in approximately 30% of sessions, and is even more frequent in certain subgroups of patients . Myocardial stunning, one of multiple ill‐effects of IDH, is associated with myocardial fibrosis, heart failure, increased risk of arrhythmias, and sudden death .…”

Section: Idh Idwg Ufr and Outcomesmentioning

confidence: 99%

Dialysate sodium and intradialytic hypotension

Hussein

Schiller

2017

Seminars in Dialysis

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Intradialytic hypotension (IDH) is a common complication in hemodialysis, particularly with the time and frequency constraints of standard session delivery in contemporary practice. High intradialytic weight gain (IDWG), high ultrafiltration rates (UFR), and frequent IDH are highly interlinked, and separately or together contribute to the high cardiovascular morbidity and mortality observed in the hemodialysis population. Using a lower concentration of sodium in the dialysate (D-Na) reduces sodium delivery to the patient during dialysis, and several studies reported the beneficial effect in controlling IDWG, UFR, and hypertension. On the other hand, high dialysate sodium is associated with more hemodynamic benefits in an unstable patient. The resulting sodium loading may, however, induce a vicious cycle of higher IDWG, requiring more rapid ultrafiltration, eventually contributing to intradialytic symptoms and hypotension. In this article, we review the available literature on fixed and profiled dialysate sodium prescriptions, and we recommend a tailored approach that considers the patient's status to optimize dialysis delivery.

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Section: Idh Idwg Ufr and Outcomesmentioning

confidence: 99%

Dialysate sodium and intradialytic hypotension

Hussein

Schiller

2017

Seminars in Dialysis

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“…In one study that included 44,801 dialysis treatments in 1137 patients, 75 percent of patients had at least one episode of intradialytic hypotension 1. In some patients, more than 50 percent of treatments are complicated by intradialytic hypotension 3 .…”

Section: Methodsmentioning

confidence: 99%

Hypotension During Haemodialysis: Aetiology, Risk Factors and Outcome

Mahmood

Hassan²,

Mahmood

et al. 2017

Anwer Khan Mod Med Coll J

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Background: Hypotension during hemodialysis is common. In some patients, the development of hypotension necessitates intravenous fluid replacement before patients are able to safely leave the dialysis unit. Intradialytic hypotension may reduce the efficacy of the dialysis procedure and contributes to the excessive morbidity and mortality that is associated with hemodialysis. Aims:The aim of the study is to identify the patients who develops intradialytic hypotension and find out the aetiology, risk factors and outcome to reduce the mortality and morbidity of those patients.Methodology: This Cross sectional descriptive type of observational study was conducted in the Haemodialysis Unit of Anwer Khan Modern Medical College Hospital over the period from January 2015 to December 2016. The change in systolic pressure during haemodialysis was reviewed for ten consecutive haemodialysis in all the patients. The patients with chronic renal failure who were on regular dialysis were enrolled. Patients with sepsis, hemoglobin level less than 9 g/dL, low cardiac output, acute coronary syndrome, significant valvular lesion or body weight below the dry weight of the patient were excluded from the study.Result: Ninetythree patients were included in the study. Among them male 53(56.98%) and female 40(43.02%) with a M:F ratio was 1.3:1. The mean age of the patients was 53.50±16.82 (Range 13-90).We found that 28%(26) of the patients developed intradialytic hypotension at least once in consecutive ten dialysis. Out of them 14 were female and 12 patients were male. All of the patients recovered from the incident after adequate management and stoppage of the ultrafiltrate volume, convert the machine to SLED(Sustained low efficacy dialysis) mode and hold antihypertensive drugs morning dose on the day of haemodialysis and treatment of the cause. Conclusion:As a result of increasing age of the patients receiving hemodialysis and the increasing incidence of diabetic nephropathy, hypotension will become a greater problem in future.Key Words: Hypotension, Haemodialysis ABSTRACT necessitates intravenous fluid replacement before patients are able to safely leave the dialysis unit.

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“…Based on current understanding, withholding BP medications prior to HD does not predictably reduce the frequency of IDH, which is caused by many compounding factors including sympathetic activation, autonomic insufficiency, cardiovascular disease burden, ultrafiltration rates, endothelial cell dysfunction, and electrolyte imbalances. 37,38 Due to the complexity of and interplay among these underlying drivers of aberrant BPs, there can be significant interpatient variability in response to the same treatment approach.…”

Section: Future Dire Ction Smentioning

confidence: 99%

Timing of blood pressure medications and intradialytic hypotension

Wang

Sirich

Chang

2019

Seminars in Dialysis

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Intradialytic hypotension (IDH) is a prevalent yet serious complication of hemodialysis, associated with decreased quality of life, inadequate dialysis, vascular access thrombosis, global hypoperfusion, and increased cardiovascular and all‐cause mortality. Current guidelines recommend antihypertensive medications be given at night and held the morning of dialysis for affected patients. Despite little evidence to support this recommendation, more than half of patients on dialysis may employ some form of this method. In this article, we will review the available evidence and clinical considerations regarding timing of blood pressure medications and occurrence of IDH, and conclude that witholding BP medications before hemodialysis should not be a routine practice.

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How Should We Manage Adverse Intradialytic Blood Pressure Changes?

Cited by 32 publications

References 64 publications

Dialysate sodium and intradialytic hypotension

Dialysate sodium and intradialytic hypotension

Hypotension During Haemodialysis: Aetiology, Risk Factors and Outcome

Timing of blood pressure medications and intradialytic hypotension

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