What is the etiology of hypotension during hemodialysis?
The causes of intradialytic hypotension can be divided into four broad categories, including volume-related issues, inadequate vasoconstriction, cardiac factors, and other causes.
Volume-related issues center around a high ultrafiltration rate, an incorrectly low dry weight, or a low sodium level in the dialysate. Vasoconstrictive factors include the use of antihypertensive medications just prior to dialysis, autonomic neuropathy, a dialysate temperature higher than the patient’s body temperature, and eating during dialysis.
Cardiac factors include cardiac ischemia, heart failure, and arrhythmias. Other, less common causes include a number of complications of dialysis that are described in more detail later, including dialyzer reactions, hemolysis, air embolism, septicemia, myocardial infarction, pericardial tamponade, and severe anemia.
