HYPOTENSION

INTRADIALYTIC

Harnavi Harun
Subbagian Ginjal Hipertensi
Bagian Ilmu Penyakit Dalam FK Unand/
RSUP DR. M. Djamil
Padang
 • A decrease in BP (SBP > 20 mmHg or
Definitio ↓ MAP by 10 mmHg) associated with
n clinical events and the need for
intervention

• Age
Risk • Renal dialysis other than
glomerulonefritis
factors • hyperphosphatemia
• Use of nitrates
 CAUSE OF INTRADIALYTIC
HYPOTENSION

• Large weight gaih (high ultrafiltration rate)

Volume related • Short weekly dialysis time (high ultrafiltration rate)
• Excessively low target (“dry” ) weight

• High dialysis solution

Inadequate •
•
Autonomic neuropathy
Antihypertensive medications
vasocontriction • Early during treatment
• Anemia
 CAUSE OF INTRADIALYTIC
HYPOTENSION

Cardiac • Diastolic dysfunction

factors
• Pericardial tamponase
• Myocardial infarction
• Occult hemmorhage
Uncommon • Septicemia
cause • Dyalizer reaction
• Hemolysis
• Air embolism
 MANAGEMENT OF HYPOTENSION

Tredelenburg position

Reducce or stop UF depending on severity

Infuse normal saline 100-250cc at a time to a max of 500cc

Reduce blood flow rate

O2 therapy

HD is terminated if hypotension remains other infusion of 500cc saline

If hypotension persists exclude gastrointestinal bleeding, acute mocardial infarction or ischemia,

cardiac arryhmias, cardiac tamponade, pulmonary embolism & electrolyte disturbances
Carry out the following investigatoin: ECG, ureas & eectrolytes, blood glucose,
arterial blood gasses.
 Strategy to Help Prevent
Hypotension During Dialysis
Use a dialysis solution temp of 35,5◦C or individualize
& set dialysis solution temp at 0,5◦C below the
patient’s average predilysis tympanic membrane temp

Review diatary soudium intake & any other

reasons for excess fluid intake

If subtansial residual kidney fucntion exists,

consider increasing urine volume using
diuretics
Strategy to Help Prevent Hypotension During
Dialysis

Extend weekly dialysis time if UF rate is >

13ml/kg/hour

Consider raisng the patient’s target weight

Give daily dose of antihypertensive medications after,

not before dialysis; change therapy to shorter-acting
agents
Strategy to Help Prevent Hypotension
During Dialysis
Assess the benefits of a predialysis hb level
consistenly= 10-11 g/dl

Do not give give food or glucose orally during, or

immediately preceding, dialysis to hypotension-prone
patients

Consider use of blood volume monitor

Consider a trial; of midodrine or sertraline

Consider use of a hoigher 9e.g 3.0 m>m) potassium

dialysis solution if predialysis levels allow