Dialysis-associated hypotension
Background
- Most frequent complication of hemodialysis (20%-30% of treatment)
Clinical Features
- Nausea/vomiting
- Anxiety
- Dizziness
- Orthostatic hypotension
- Syncope
Differential Diagnosis
- Excessive ultrafiltration
- > 0.35 ml/min/kg
- >20% plasma volume
- Predialytic volume loss
- Intradialytic volume loss
- Tube and hemodialyzer blood losses
- Postdialytic volume loss
- Vascular access blood loss
- Hemorrhage
- Medication effects
- Decreased vascular tone (sepsis)
- Cardiac dysfunction
- LVH, ischemia, hypoxia, arrhythmia, pericardial tamponade
- Pericardial disease
- Effusion
- Tamponade
- Hemolysis
Dialysis Complications
- Dialysis-associated hypotension
- Dialysis disequilibrium syndrome
- Air embolism
- Missed dialysis (pulmonary edema)
Evaluation
Assess:
- Volume status (US)
- Cardiac function
- Pericardial disease
- Infection
- GI bleeding
Evaluation by HypotensionTiming
- Early in session: usually due to preexisting hypovolemia
- During the session: often due to blood loss (from tubing or filter leak)
- Near the end: usually result of excessive ultrafiltration
- Underestimation of patient's ideal blood volume (dry weight)
- Also consider pericardial or cardiac disease
Management
Disposition
See Also
External Links
References
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