Dialysis-associated hypotension

Background

  • Most frequent complication of hemodialysis (20%-30% of treatment)

Clinical Features

Differential Diagnosis

  • Excessive ultrafiltration
    • > 0.35 ml/min/kg
    • >20% plasma volume
  • Predialytic volume loss
    • GI losses
    • Decreased oral intake
  • Intradialytic volume loss
    • Tube and hemodialyzer blood losses
  • Postdialytic volume loss
    • Vascular access blood loss
  • Hemorrhage
  • Medication effects
    • Antihypertensives
    • Opiates
  • Decreased vascular tone (sepsis)
  • Cardiac dysfunction
    • LVH, ischemia, hypoxia, arrhythmia, pericardial tamponade
  • Pericardial disease
  • Hemolysis

Dialysis Complications

Evaluation

Assess:

  • Volume status (US)
  • Cardiac function
  • Pericardial disease
  • Infection
  • GI bleeding

Evaluation by HypotensionTiming

  • Early in session: usually due to preexisting hypovolemia
  • During the session: often due to blood loss (from tubing or filter leak)
  • Near the end: usually result of excessive ultrafiltration
    • Underestimation of patient's ideal blood volume (dry weight)
    • Also consider pericardial or cardiac disease

Management

Disposition

See Also

External Links

References