Prevention of Hypotension During Dialysis

Hypotension during dialysis is a common complication in haemodialysis patients,
which typically occurs during the later stages of dialysis. It is estimated that
hypotension occurs 25 to 50% of dialysis treatments (Victor and Henrich 1994 pg196-
208). Many factors involve in hypotension during dialysis including volume
depletion, high ultrafiltration rate, autonomic dysfunction, antihypertensive
medications, bioincompatible dialyser membrane, low dialysate temperature,
declining serum osmolarity etc. (Daugirdas 1991 pg 233). However, in spite of
appropriate treatment, many patients still suffer from hypotension during
haemodialysis. Collins et al (1990) when hypotension occurred the cardiac output
drops sharply and there were concomitant sudden decrease in the mean arterial
pressure and are attributed to a decrease venous return and considered to be caused by relocation of circulating blood, possible associated a sudden decrease in venous tone which will result in hypotension. The etiology and prevention of intradialytic
hypotension has become an increasingly complex issue and the volume depletion due
to ultrafiltration remains the predominant underlying etiologic factor, Sherman et al
(2002).
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