Intradialytic hypotension: an overview of recent, unresolved and overlooked issues

The etiology and management of intradialytic hypotension has become an increasingly complex issue. Volume depletion due to ultrafiltration remains the predominant underlying etiologic factor. However, patients vary markedly in their hemodynamic tolerance to fluid removal. While many risk factors have been identified, the issues of sodium and thermal balance and variability in left ventricular filling have not been adequately emphasized or investigated.