Intradialytic hypotension in patients with ESKD on maintenance hemodialysis is associated with adverse outcomes, including higher cardiovascular and all-cause mortality.
This review highlights the pathophysiology and adverse outcomes of intradialytic hypotension in ESKD patients, emphasizing the need for effective prevention and treatment strategies.
Individuals with ESKD requiring maintenance hemodialysis face a unique hemodynamic challenge, typically on a thrice-weekly basis. In an effort to achieve some degree of euvolemia, ultrafiltration goals often involve removal of the equivalent of an entire plasma volume. Maintenance of adequate end-organ perfusion in this setting is dependent on the institution of a variety of complex compensatory mechanisms. Unfortunately, secondary to a myriad of patient- and dialysis-related factors, this compensation often falls short and results in intradialytic hypotension. Physicians and patients have developed a greater appreciation for the breadth of adverse outcomes associated with intradialytic hypotension, including higher cardiovascular and all-cause mortality. In this review, we summarize the evidence for adverse outcomes associated with intradialytic hypotension, explore the underlying pathophysiology, and use this as a basis to introduce potential strategies for its prevention and treatment.
Reeves et al. (Mon,) conducted a review in End-stage kidney disease requiring maintenance hemodialysis. Intradialytic hypotension was evaluated. Intradialytic hypotension in patients with ESKD on maintenance hemodialysis is associated with adverse outcomes, including higher cardiovascular and all-cause mortality.