Intradialytic Hypotension Causes and Prevention

True Causes of Intradialytic Hypotension

• Excessive ultrafiltration volume and rate is responsible for 70% of premature dialysis terminations due to hypotension and cramping, as reported by the American Journal of Kidney Diseases 1
• Inadequate achievement of appropriate dry weight, where the target may be set too low, causing hypovolemia, is a cause of intradialytic hypotension, according to the American Journal of Kidney Diseases 1, 2
• Dialysate-related factors, including acetate-containing dialysate and elevated dialysate temperature, contribute to intradialytic hypotension, as noted by the American Journal of Kidney Diseases 1

Prevention and Monitoring

• Addressing true hypotension by slowing ultrafiltration rate, reassessing dry weight, increasing dialysate sodium to 148 mEq/L, reducing dialysate temperature to 34-35°C, and administering midodrine 30 minutes before dialysis is recommended, as suggested by the American Journal of Kidney Diseases and Praxis Medical Insights 1, 3, 4

Circuit Pressures vs. Patient Blood Pressure

• Patient blood pressure during dialysis is monitored separately and responds to ultrafiltration, volume status, and cardiovascular factors, as reported by the American Journal of Kidney Diseases 1, 2
• Prepump arterial pressure ≥200 mmHg indicates access problems, not tubing kinks, according to Praxis Medical Insights 3