Intradialytic hypotension

Intradialytic Hypotension (IDH) is a common complication associated with hemodialysis, which is a treatment for patients with end-stage renal disease (ESRD). IDH is characterized by a significant drop in blood pressure during or immediately after the dialysis session. This condition can lead to various adverse effects, including dizziness, nausea, fatigue, and in severe cases, cardiac arrest or stroke. Understanding the causes, prevention, and management strategies of IDH is crucial for improving patient outcomes and quality of life.

Causes

The primary cause of IDH is the removal of fluid from the blood at a rate or volume that exceeds the body's ability to compensate, leading to a decrease in blood volume and, consequently, blood pressure. Other factors contributing to IDH include:

• High ultrafiltration rates
• The use of antihypertensive medications
• A high interdialytic weight gain
• Diabetes mellitus
• Advanced age
• The presence of cardiovascular diseases

Symptoms

Symptoms of IDH may vary among patients but commonly include:

• Dizziness
• Nausea
• Fatigue
• Muscle cramps
• Yawning
• Sweating
• Blurred vision

Prevention and Management

Preventing and managing IDH involves a multifaceted approach tailored to the individual patient's needs. Strategies include:

• Adjusting the ultrafiltration rate to a more gradual fluid removal
• Pre-dialysis patient assessment to tailor the dialysis session appropriately
• Using isotonic saline infusions or increasing the sodium concentration in the dialysis fluid to improve vascular refilling
• Monitoring and adjusting antihypertensive medication before dialysis sessions
• Encouraging patients to limit fluid intake between dialysis sessions to minimize interdialytic weight gain

Conclusion

Intradialytic hypotension remains a significant challenge in the management of patients undergoing hemodialysis. Through careful assessment and individualized treatment plans, healthcare providers can mitigate the risks associated with IDH, thereby improving the safety and effectiveness of hemodialysis treatment.