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Nephrol Dial Transplant (2000) 15: 1746-1748
© 2000 European Renal Association-European Dialysis and Transplant Association

Editorial Comments

Intradialytic hypotension—new concepts on an old problem

Frank M. van der Sande, Jeroen P. Kooman and Karel M. L. Leunissen

Department of Internal Medicine and Nephrology, University Hospital Maastricht, Maastricht, The Netherlands

Introduction

Intradialytic hypotension continues to be a leading problem, especially in the elderly and cardiovascularly compromised patient. This predominance can be explained by the fact that structural and functional abnormalities of the heart and blood vessels increase the sensitivity of the patient to changes in fluid status.

Intradialytic hypotension not only causes discomfort, but also increases mortality. According to recent data a low post-dialytic blood pressure was associated with a significantly increased risk for mortality [1]. Therefore prevention of intradialytic hypotension, especially in the elderly and vulnerable patient, remains an important challenge to the dialysis physician.

How to improve stability of blood volume?

The initiating factor in the pathogenesis of intradialytic hypotension is a decrease in blood volume. The decrease of blood volume is the consequence of the capillary Starling equilibrium, which determines the refilling rate. Many factors influence the refilling rate. As a result it is difficult to predict the changes of blood volume during . . . [Full Text of this Article]

Ultrafiltration rate
Dialysate sodium
How to improve (cardio)vascular reactivity?

Thermal effects
Practical guidelines

Conclusion

Notes

References


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