Managing hypotensive episodes during dialysis part 1

Haemodialysis 5

 

Hypotension on dialysis can have several causes. An individual it may be multifactorial:

  • When the rate of fluid removal exceeds vascular refilling rate. This is more likely to occur when ultrafiltration exceeds the rate of 10-15 ml/kg/hours and when fluid gain between dialysis sessions is excessive
  • When a dry weight is not correct and is too low
  • When antihypertensive medication or medication affecting the pulse rate does not allow physiological adaptation to fluid removal
  • With significant cardiac disease preventing physiological adaptation to fluid removal. This includes significant left ventricular failure, dialysis-induced ischaemia and rhythm abnormalities
  • When a patient has significant extra-kidney fluid losses resulting in reduced intravascular volume either temporarily e.g. diarrhoea and vomitting, blood loss on dialysis or long term e.g.  high output ileostomy
  • With serious infection particularly sepsis syndrome
  • As a chronic condition in long term, particularly anephric patients
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