Search

Intradialytic Complications Management

Updated: Jan 5


When intradialytic complications occur they are a consequence of an interaction between the patient’s physiology and dialysis-induced processes.


Intradialytic hypotension (IDH) is considered to be one of the most frequent complications of hemodialysis (HD).


Etiology of Intradialytic Hypotension


Patient related factors -


Impaired plasma volume refilling (too high ultrafiltration, autonomic dysfunction)

Decreased cardiac reserve (diastolic or systolic dysfunction)

Impaired venous compliance

Autonomic dysfunction (diabetes, uremia)

Arrhythmias

Anemia

Drug therapy (vasodilators, ß blockers, calcium channel blockers)

Alteration of vasoactive substances in blood

Eating during treatment (increased splanchnic blood flow)

Too low target weight estimation

Procedure related factors -


Rapid decrease in plasma osmolality (relatively large surface area membrane, high starting BUN)

Excess absolute volume and rate of fluid removal (for fluid overload)

Change in serum electrolytes (hypocalcemia, hypokalemia)

Dialysate – acetate, warm dialysate

Membrane blood interaction

Hypoxia (partially patient related)

Other less common causes -


Pericardial tamponade

Myocardial infarction

Aortic dissection

Internal or external hemorrhage

Septicemia

Air embolism

Pneumothorax

Hemolysis


Pathogenesis


Vascular instability during dialysis is a multifactorial process in which procedure and patient related factors may influence the decrease in plasma volume and induce an impairment of cardiovascular regulatory mechanisms. An awareness of the risk factors and by identifying those patients who are most susceptible may significantly improve cardiovascular stability during dialysis. Among high-risk patients, monitoring and biofeedback of the various hemodynamic variables, together with an extensive use of convection, can prevent the appearance of symptomatic hypotension and help in averting its onset.


Treatment


Stop or reduce ultrafiltration

Place patient in Trendelenburg position

Administration of saline and hypertonic agents. However, excess fluid replacement should be avoided to prevent sodium overload.

Continuous infusion of pressor agents (meteraminol, norepinephrine) are very rarely needed

Prevention


Patient end strategy


Reduce intradialytic weight gain (dietary and treatment compliance)

Avoid anti-hypertensive medication on the morning of the dialysis day

Avoid missing dialysis and stay the entire dialysis time for treatment

Avoid eating during dialysis

Procedure related strategy


Dialysate sodium- sodium profiling and sodium gradient protocol but maintaining zero sodium balance to the extent possible

Modeling fluid removal- sequential ultrafiltration and dialysis, blood volume controlled hemodialysis

Cool dialysate- isothermic dialysis is well tolerated and clearly reduces the incidence of hypotension

Reduction of the ultrafiltration rate with prolongation of treatment time

Accurate estimation of dry weight (segmental bioimpedance, and others)

Judiciously increasing dialysate calcium while avoiding hypercalcemia

Medications-

Midodrine given approximately 30 min before dialysis significantly reduces the incidence of hypotension. It has been considered safe and well tolerated.

Carnitine has been recommended in-patients with frequent hypotensive episodes.

References:


1. Straver B, De Vries PM, Donker AJ, ter Wee PM. The effect of profiled hemodialysis on intradialytic hemodynamics when a proper sodium balance is applied. Blood Purif 20:364-369, 2002

2. Santoro A, Mancini E, Basile C, Amoroso L, Di Giulio S, Usberti M, Colasanti G, Verzetti G, Rocco A, Imbasciati E, Panzetta G, Bolzani R, Grandi F, Pola…


FIND OUT MORE KNOWLEDGE IN OUR HEALTHCARE TRAINING PROGRAM.


CLICK Here TO JOIN OUR TRAINING






37 views

Qudrat Medicare

Our Services

Address

Your Healthcare Training Provider

Qudrat MediCare was established in 2015 under the name of Qudrat Aura Sdn. Bhd. We are specializing in healthcare training provider and conducted cpr, first aid program,dialysis training program and healthcare safety training program in Malaysia.

No. 8, 2nd Floor Jalan Kasuarina 11/ks07,

Bandar Botanik, 41200 Klang,

Selangor

qudrataura@gmail.com

011-16566976