Table 2.
Prevention and Management of Intradialytic Hypotension
| ACUTE MANAGEMENTa | |
| Evaluation for life-threatening causes | Hemolysis, Air embolus, Dialyzer reaction, Coronary ischemia, Pulmonary embolus Pericardial tamponade, Bleeding Sepsis |
| Stop Ultrafiltration | |
| Place patient in Trendelenburg | |
| Administer Oxygen | |
| Replace intravascular volume | |
| Early termination of dialysis and transfer to hospital, if IDH is severe and/or refractory | |
| PREVENTION | |
| I. Patient Education | |
| Low salt diet | ≤5g/day to reduce IDWG |
| Avoid eating during dialysis | To prevent drop in peripheral vascular resistance |
| II. HD treatment | |
| Weight | Avoid “dry weight” goal if it necessitates UFR >10mL/hr/kg |
| Dialysate Calcium | Keep ≥ 2.25 mmol/L |
| Dialysate Temperature | Empiric reduction by 0.5 or 1.0°F, or isothermic biofeedback reduction |
| Dialysis Frequency or modality | More frequent and/or longer hemodialysis. If IDH refractory, consider peritoneal dialysis |
| Monitoring devices | Blood volume monitoring, bioimpedance, biofeedback ultrafiltration |
| Dialysate Sodium | Sodium modelling and/or high sodium (>140mEq/L) not recommended, as associated with increased IDWG |
| III. Medication | |
| Stop anti-hypertensives prior to hemodialysis | Preferential use of once or twice daily medication dosing |
| Midodrine | Use limited by side effects (pruritus, pilomotor reactions) |
a
Steps in acute management should occur simultaneously
IDH: intradialytic hypotension; IDWG: Interdialytic weight gain; HD: hemodialysis;