Symptomatic Intradialytic Hypotension and Mortality: An Opinionated Review

Abstract

The unchanging rate of symptomatic hypotension that attends maintenance hemodialysis and its link to sodium/volume overload are explored. Correlations between interdialytic weight gain, ultrafiltration rate, hypertension, and mortality are found to be strong. Suggestions/opinions for correcting this unfortunate clinical reality are offered.

Intradialytic hypotension is associated with dialytic age in patients on chronic hemodialysis

“…3,4 IDH causes a drop in cardiac output, which may lead to multiorgan dysfunction with an increased risk of myocardial infarction, heart failure, and neurologic complications. [4][5][6][7][8] Several factors might account for the association of IDH with DA.…”

“…3,4 IDH causes a drop in cardiac output, which may lead to multiorgan dysfunction with an increased risk of myocardial infarction, heart failure, and neurologic complications. [4][5][6][7][8] Several factors might account for the association of IDH with DA. [5][6][7][8][9][10] It has been reported that endothelial dysfunction is associated with IDH due to the effect of dialysis on several serum mediators of the endothelial function.…”

“…In addition, IDH may cause organ hypoperfusion resulting in cardiac, neurologic, vascular, and gastrointestinal complications. [4][5][6][7][8] Overall, IDH causes discomfort, and reduces treatment efficacy, thus increases morbidity.…”

“…[4][5][6][7][8] Several factors contribute to IDH, such as the compromised autonomic nervous system, hormonal response, and cardiovascular compensatory mechanisms, including vascular compliance, venous capacity, and cardiac function. In addition, during hemodialysis treatment, fast removal of intravascular fluid, slow refilling rates, increases in body temperature, components of the dialysis fluid (buffer, water and electrolytes), etc.…”

Clinical Effects of Personalized Dialysate Sodium in Conventional, Quotidian, and Nocturnal Home Hemodialysis Patients: A Randomized Crossover Trial

“…Previous trials in thrice weekly conventional haemodialysis patients have demonstrated that low dialysate sodium increases risk for intradialytic hypotension [39-41]. However intradialytic hypotension occurs when increases in plasma volume from compartments outside plasma occur slower than haemodialysis reduces plasma volume [40,42]. Our study population had longer haemodialysis duration than previous trials (mean 4.8 hours, interquartile range 3-7 h (Table 1).…”