Cardiovascular dialysis instability and convective therapies.

Acute hypotension is a frequent hemodialysis complication. Intratreatment vascular instability is a multifactorial process in which procedure-related and patient-related factors may influence the decrease in plasma volume and induce an impairment of cardiovascular regulatory mechanisms. Identification of the most susceptible patients and of the various risk factors may contribute to significantly improve cardiovascular stability during dialysis. In some high-risk patients, monitoring and biofeedback of the various hemodynamic variables, together with an extensive use of convection, can prevent the appearance of symptomatic hypotension and help in averting its onset.