Journal
CLINICAL KIDNEY JOURNAL
Volume 13, Issue 6, Pages 981-993Publisher
OXFORD UNIV PRESS
DOI: 10.1093/ckj/sfaa078
Keywords
cardiovascular event; haemodialysis; intradialytic hypotension; roadmap; ultrafiltration
Categories
Funding
- Ministry of Research and Innovation, CNCS-UEFISCDI, within PNCDI III [PN-III-P4-ID-PCE-2016-0908, 167/2017, ISCIII FIS PI16/02057, PI19/00588, PI19/00815, DTS18/00032, ERA-PerMed-JTC2018, AC18/00064, PERSTIGAN AC18/00071]
- ISCIII-RETIC REDinREN FEDER funds [RD016/0009]
- Fundacion Renal Inigo Alvarez de Toledo (FRIAT)
- Comunidad de Madrid [CIFRA2 B2017/BMD-3686]
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Intradialytic hypotension (IDH) is a frequent and serious complication of chronic haemodialysis, linked to adverse longterm outcomes including increased cardiovascular and all-cause mortality. IDH is the end result of the interaction between ultrafiltration rate (UFR), cardiac output and arteriolar tone. Thus excessive ultrafiltration may decrease the cardiac output, especially when compensatory mechanisms (heart rate, myocardial contractility, vascular tone and splanchnic flow shifts) fail to be optimally recruited. The repeated disruption of end-organ perfusion in IDH may lead to various adverse clinical outcomes affecting the heart, central nervous system, kidney and gastrointestinal system. Potential interventions to decrease the incidence or severity of IDH include optimization of the dialysis prescription (cool dialysate, UFR, sodium profiling and high-flux haemofiltration), interventions during the dialysis session (midodrine, mannitol, food intake, intradialytic exercise and intermittent pneumatic compression of the lower limbs) and interventions in the interdialysis period (lower interdialytic weight gain and blood pressure-lowering drugs). However, the evidence base for many of these interventions is thin and optimal prevention and management of IDH awaits further clinical investigation. Developing a consensus definition of IDH will facilitate clinical research. We review the most recent findings on risk factors, pathophysiology and management of IDH and, based on this, we call for a new consensus definition of IDH based on clinical outcomes and define a roadmap for IDH research.
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