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Setting the stage.

M J Schreiber1

  • 1Department of Nephrology and Hypertension, Cleveland Clinic Foundation, Cleveland, OH 44195, USA. schreim@ccf.org

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
|October 17, 2001
PubMed
Summary

Intradialytic hypotension (IDH) affects up to 50% of end-stage renal disease (ESRD) hemodialysis (HD) treatments. Managing IDH requires personalized HD prescriptions and pharmacologic interventions to prevent serious complications.

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Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Critical Care

Background:

  • Intradialytic hypotension (IDH) complicates 25-50% of end-stage renal disease (ESRD) hemodialysis (HD) treatments.
  • IDH presents with diverse symptoms and is linked to increased mortality risk in ESRD patients.
  • Recent research highlights hypotension's role in ESRD outcomes, contrasting with traditional hypertension focus.

Purpose of the Study:

  • To explore the pathophysiology of intradialytic hypotension (IDH) in ESRD patients undergoing hemodialysis (HD).
  • To review HD prescription modifications and pharmacologic strategies for preventing and treating IDH.
  • To emphasize identifying high-risk patients and customizing HD protocols.

Main Methods:

  • Review of current literature on IDH pathophysiology and management.
  • Discussion of technological and patient-dependent factors contributing to IDH.
  • Analysis of clinical case studies to illustrate management approaches.

Main Results:

  • IDH is associated with mechanisms including acute coronary syndrome, autoregulation dysfunction, ischemia, and arrhythmogenicity.
  • Endothelial dysfunction and altered myocardial vascular distribution contribute to vascular injury.
  • Personalized HD prescriptions and pharmacologic therapies are crucial for IDH management.

Conclusions:

  • Effective IDH management necessitates identifying at-risk patients and tailoring HD prescriptions.
  • Pharmacologic interventions play a vital role in preventing and treating IDH events.
  • Continuous monitoring of chronic hypotension and IDH complications is essential in dialysis units.

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