Document Detail

How can we prevent intradialytic hypotension?
MedLine Citation:
PMID:  22914686     Owner:  NLM     Status:  MEDLINE    
PURPOSE OF REVIEW: Intradialytic hypotension (IDH) produces uncomfortable symptoms for the patient and reduces the efficiency of dialysis.
RECENT FINDINGS: IDH may be an important cause of vascular access thrombosis. Automatic biofeedback-controlled dialysis changes dialysate conductivity and ultrafiltration during dialysis. A number of trials suggest that automatic feedback-controlled dialysis improves IDH in part by improvement in myocardial stunning and preservation of cardiac function. However, the effects of automatic biofeedback dialysis are inconsistent between studies and sample sizes are small. Acetate even in small amounts may trigger IDH especially in predisposed patients. Cool temperature dialysate causes vasoconstriction, activates the sympathetic nervous system, preserves central blood volume, and mitigates IDH. Increasing the treatment time to at least 4 h three times a week and limiting dialysate and dietary sodium intake are effective ways to reduce IDH. Ultrafiltration profiling needs further work, but it appears that removing more fluid during the first hour of dialysis and reducing the rate later on may also reduce IDH.
SUMMARY: Adequate prescription and frequency of dialysis treatments, limiting dietary and dialysate sodium, ultrafiltration profiling, automatic biofeedback-controlled dialysis, avoidance of acetate, and cool temperature dialysate may be effective strategies to reduce IDH.
Rajiv Agarwal
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.; Research Support, U.S. Gov't, P.H.S.; Review    
Journal Detail:
Title:  Current opinion in nephrology and hypertension     Volume:  21     ISSN:  1473-6543     ISO Abbreviation:  Curr. Opin. Nephrol. Hypertens.     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-10-18     Completed Date:  2013-03-29     Revised Date:  2013-05-02    
Medline Journal Info:
Nlm Unique ID:  9303753     Medline TA:  Curr Opin Nephrol Hypertens     Country:  England    
Other Details:
Languages:  eng     Pagination:  593-9     Citation Subset:  IM    
Indiana University School of Medicine and Richard L Roudebush VA Medical Center, Indianapolis, Indiana 46202, USA.
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MeSH Terms
Automation, Laboratory
Dialysis Solutions / therapeutic use
Equipment Design
Hypotension / diagnosis,  etiology,  physiopathology,  prevention & control*
Kidney Failure, Chronic / therapy*
Kidneys, Artificial
Renal Dialysis / adverse effects*,  instrumentation,  methods
Risk Factors
Time Factors
Treatment Outcome
Grant Support
2R01-DK062030-08/DK/NIDDK NIH HHS
Reg. No./Substance:
0/Dialysis Solutions

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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