Liver Blood Stagnation: An Overlooked but Significant Factor in Intradialytic Hypotension

BACKGROUND: Intradialytic hypotension (IDH) occurs suddenly and without warning, although it is generally reversible. While ultrafiltration rate, cardiac function, and vascular resistance have been widely studied, more attention should be given to venous blood return to the heart in relation to blood stagnation. Both existing literature and clinical observations suggest that as a hemodialysis session progresses, the vascular bed of the liver expands, reducing venous return to the heart. This decrease in cardiac output may further increase hepatic blood volume, potentially playing a central role in the development of IDH. SUMMARY: This review explores the role of reduced venous return to the heart, caused by liver blood stagnation, as a key contributor to IDH. KEY MESSAGES: We tentatively name this pathophysiological mechanism "liver circulation jam." The clinical significance of this concept requires validation through future research.