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Clin J Am Soc Nephrol. 2018 Aug 7;13(8):1297-1303. doi: 10.2215/CJN.12141017. Epub 2018 Feb 26.

Mechanisms, Clinical Implications, and Treatment of Intradialytic Hypotension.

Author information

1
Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; and.
2
Harvard Medical School, Boston, Massachusetts.
3
Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; and fmccausland@bwh.harvard.edu.

Abstract

Individuals with ESKD requiring maintenance hemodialysis face a unique hemodynamic challenge, typically on a thrice-weekly basis. In an effort to achieve some degree of euvolemia, ultrafiltration goals often involve removal of the equivalent of an entire plasma volume. Maintenance of adequate end-organ perfusion in this setting is dependent on the institution of a variety of complex compensatory mechanisms. Unfortunately, secondary to a myriad of patient- and dialysis-related factors, this compensation often falls short and results in intradialytic hypotension. Physicians and patients have developed a greater appreciation for the breadth of adverse outcomes associated with intradialytic hypotension, including higher cardiovascular and all-cause mortality. In this review, we summarize the evidence for adverse outcomes associated with intradialytic hypotension, explore the underlying pathophysiology, and use this as a basis to introduce potential strategies for its prevention and treatment.

KEYWORDS:

Chronic; Fluid Therapy; Goals; Hemodialysis; Hemodynamics; Humans; Kidney Failure; Physicians; Plasma Volume; blood pressure; end-stage renal disease; hypotension; renal dialysis; ultrafiltration

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