Management of hypotension during dialysis in patient with chronic kidney disease

Abstract

IDH is the most common complication during heamodialysis, Repeated episodes of IDH have been established as a significant and independent risk factor for increased morbidityand mortality in hemodialysis patients. This makes treatment and prevention of IDH an important part of both short- and long-term HD strategy. IDH may also carry the risk of reduced perfusion to other vascular beds in vulnerable organ systems, such as brain and therefore contribute to the higher risk of cerebrovascular events in dialysis patient. IDH is the clinical manifestation of an imbalance between the decreases in plasma volume during dialysis and the counter regulatory cardiovascular hemodynamic and neurohumoral mechanisms. Some features of IDH are directly related to the dialysis procedure itself such as ultrafiltration rate, increased temperature, and acetate dialysate. Several patient characteristics increase the risk of IDH, such as older age, diabetes, left ventricular hypertrophy, coronary artery disease, autonomic neuropathy, excessive intradialytic weight gain and low ejection fraction. IDH can induce cardiac arrhythmias and predispose to myocardial ischemia, and myocardiac stunning, which in turn increases the risk for sudden cardiac death, being a common cause of death in dialysis patients.