Intradialytic Hypotension: Mechanisms and Prevention

Abstract

Introduction: Intradialytic hypotension (IDH) occurs in 20–30% of hemodialysis sessions and associates with mortality. Methods: Systematic review of 35 studies on pathogenesis, risk factors, and interventions for IDH. Results: Key mechanisms include rapid ultrafiltration, reduced cardiac reserve, and autonomic dysfunction. Cool dialysate (35–36°C) reduced IDH by 50%. Sodium profiling and midodrine pre-dialysis lowered IDH episodes by 40%. Discussion: Avoiding large interdialytic weight gain, longer sessions, and biofeedback dialysis are effective. Conclusion: Multifactorial prevention strategies tailored to patient physiology are needed.