Managing low blood pressure during dialysis

 The commonest complication during dialysis is hypotension, meaning low blood pressure.

Intradialytic hypotension is defined as a decrease in systolic blood pressure by ≥ 20 mm Hg or a decrease in mean arterial pressure by 10 mm Hg, after commencement of dialysis.

It is associated with symptoms that include abdominal discomfort, yawning, sighing, nausea, vomiting, muscle cramps, restlessness, dizziness or fainting, and anxiety. 

The incidence of a symptomatic reduction in blood pressure during (or immediately following) dialysis ranges from 15-50% of dialysis sessions. It is a major cause for morbidity in elderly hemodialysis patients and those with cardiovascular compromise. It impairs patient well-being, limits

 This happens when the blood is pulled out from the body for cleansing via the dialyzer or artificial kidney; and the body cannot sustain its blood pressure.

Some common causes include

1. Rapid fluid removal in an attempt to attain "dry weight," particularly among those with large inter-dialytic weight gains

2. Intake of blood pressure medications before dialysis

3. Eating heavy meals before dialysis

4. Low blood level 

5. Heart diseases

6. Use of low sodium dialysate

How should patients with intradialytic hypotension be managed?

Remember this first 3 steps

1.Reduce the ultrafiltration rate or stop ultrafiltration.

2.Place the patient in the Trendelenburg position. This means the legs are raised higher than the chest and head to aid return of blood to the heart

3.Infuse boluses of 100 mL of 0.9% isotonic saline as necessary (first choice of fluid).

Other things that can be done include

4. Reducing the temperature of the dialysate

5. Increasing the amount of Sodium in the dialysate fluid, a process called Sodium Profiling.

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