Intradialytic Hypotension Causes and Management

Prevalence and Clinical Relevance

The American Society of Nephrology recommends that intradialytic hypotension, which occurs in approximately 25% of all hemodialysis sessions, requires immediate intervention to prevent severe cardiovascular complications 3
The Kidney Disease Outcomes Quality Initiative suggests that the prevalence of intradialytic hypotension varies from 15% to 50% of hemodialysis treatments, depending on the definition used 1, 2
Intradialytic hypotension is associated with vascular access thrombosis, inadequate dialysis dose, and mortality, according to the Kidney International guidelines 1, 2

The National Kidney Foundation states that patients with pre-dialysis systolic blood pressure <100 mm Hg have a higher risk of developing intradialytic hypotension 4, 3
The European Renal Association recommends that the magnitude of blood pressure decrease during a dialysis session is closely related to the magnitude of ultrafiltration, with excessive ultrafiltration being a primary cause of intradialytic hypotension 1, 2

The American College of Cardiology suggests that reevaluation of blood pressure should include, but not be limited to, ultrafiltration rate, dialysis treatment time, interdialytic weight gain, dry weight estimation, and use of antihypertensive medications 1, 2