BACKGROUND: Intradialytic hypotension (IDH) is a common complication of haemodialysis (HD) and associated with adverse outcomes, especially when a nadir definition (systolic blood pressure <90 mm Hg) is used. The pathogenesis of IDH is directly linked to the discontinuous nature of the HD treatment, in combination with patient-related factors such as age, diabetes mellitus and cardiac failure. SUMMARY: Although the decline in blood volume due to removal of fluid by ultrafiltration is the prime mover, thermally induced reflex vasodilation compromises the haemodynamic response to hypovolemia. Recent studies have stressed the relevance of changes in tissue perfusion during HD, which may translate in long-term organ damage. Monitoring changes in tissue perfusion, for which emerging evidence becomes available, appears to have great promise in the fine-tuning of the dialysis procedure. Key Messages: While it is unlikely that IDH can be completely prevented, reduction in inter-dialytic weight gain, prevention of an increase in core temperature by adjusting the dialysate temperature and more frequent or prolonged dialysis treatment remain cornerstones in providing a more comfortable and safe treatment.
BACKGROUND: Intradialytic hypotension (IDH) is a common complication of haemodialysis (HD) and associated with adverse outcomes, especially when a nadir definition (systolic blood pressure <90 mm Hg) is used. The pathogenesis of IDH is directly linked to the discontinuous nature of the HD treatment, in combination with patient-related factors such as age, diabetes mellitus and cardiac failure. SUMMARY: Although the decline in blood volume due to removal of fluid by ultrafiltration is the prime mover, thermally induced reflex vasodilation compromises the haemodynamic response to hypovolemia. Recent studies have stressed the relevance of changes in tissue perfusion during HD, which may translate in long-term organ damage. Monitoring changes in tissue perfusion, for which emerging evidence becomes available, appears to have great promise in the fine-tuning of the dialysis procedure. Key Messages: While it is unlikely that IDH can be completely prevented, reduction in inter-dialytic weight gain, prevention of an increase in core temperature by adjusting the dialysate temperature and more frequent or prolonged dialysis treatment remain cornerstones in providing a more comfortable and safe treatment.
Authors: Jeroen P Kooman; Len A Usvyat; Marijke J E Dekker; Dugan W Maddux; Jochen G Raimann; Frank M van der Sande; Xiaoling Ye; Yuedong Wang; Peter Kotanko Journal: Blood Purif Date: 2018-11-16 Impact factor: 2.614
Authors: Francesco Peyronel; Elisabetta Parenti; Paride Fenaroli; Giuseppe Daniele Benigno; Giovanni Maria Rossi; Umberto Maggiore; Enrico Fiaccadori Journal: BMJ Open Date: 2020-07-08 Impact factor: 2.692
Authors: Hanjie Zhang; Priscila Preciado; Yuedong Wang; Anna Meyring-Wosten; Jochen G Raimann; Jeroen P Kooman; Frank M van der Sande; Len A Usvyat; Dugan Maddux; Franklin W Maddux; Peter Kotanko Journal: Nephrol Dial Transplant Date: 2020-09-01 Impact factor: 5.992
Authors: Paul A Rootjes; Camiel L M de Roij van Zuijdewijn; Muriel P C Grooteman; Michiel L Bots; Bernard Canaud; Peter J Blankestijn; Frans J van Ittersum; Francisco Maduell; Marion Morena; Sanne A E Peters; Andrew Davenport; Robin W M Vernooij; Menso J Nubé Journal: Kidney Int Rep Date: 2020-01-31
Authors: Rogerio da Hora Passos; Juliana Caldas; Joao Gabriel Rosa Ramos; Erica Batista Dos Santos Galvão de Melo; Michel Por Deus Ribeiro; Maria Fernanda Coelho Alves; Paulo Benigno Pena Batista; Octavio Henrique Coelho Messeder; Augusto Manoel de Carvalho de Farias; Etienne Macedo; Jean Jacques Rouby Journal: Crit Care Date: 2019-12-02 Impact factor: 9.097