Hypotension in dialysis is one of the common complications in hemodialysis. It occurs quickly and often makes hemodialysis fail smoothly, resulting in inadequate dialysis, affecting the efficiency and quality of dialysis, and even threatening patients’ lives in serious cases.
To strengthen and pay attention to the prevention and treatment of hypotension in dialysis patients is of great significance to improve the survival rate and life quality of maintenance hemodialysis patients.

What is dialysis medium low blood pressure

• Definition

Hypotension on dialysis is defined as a drop in systolic blood pressure greater than 20mmHg or a drop in mean arterial blood pressure greater than 10mmHg, according to the 2019 edition of the latest KDOQI (American foundation for kidney disease) published by the NKF.

• Symptom

Early stage can have lack of power, giddy, perspire, abdominal pain, nausea, vomiting, can have dyspasm, muscle, amaurosis, angina pectoris as illness progress, appear consciousness to lose even, myocardial infarction, partial patient does not have symptom.

• Occurrence Rate

Hypotension in dialysis is one of the common complications of hemodialysis, especially in the elderly, diabetes and patients with cardiovascular diseases, and the incidence of hypotension in ordinary dialysis is more than 20%.

• Endanger

1. Affected patients’ normal dialysis, some patients were forced to get off the machine in advance, affecting the adequacy and regularity of hemodialysis.
2. Affecting the service life of internal fistula, long-term hypotension will increase the incidence of internal fistula thrombosis, resulting in the failure of arteriovenous internal fistula
3. Increased risk of death. Studies show that the 2-year fatality rate of patients with frequent IDH is as high as 30.7%.

Why produce low blood pressure in dialysis

• Capacity dependent factor

1. Excessive ultrafiltration or fast ultrafiltration
2. Incorrect calculation of dry weight or failure to calculate the patient’s dry weight on time
3. Insufficient dialysis time per week
4. Sodium concentration of dialysate is low

• Vasoconstrictor dysfunction

1. The dialysate temperature is too high
2. Take blood pressure medication before dialysis
3. Feeding on dialysis
4. Moderate to severe anemia
5. Endogenous vasodilators
6. Autonomic neuropathy

• Hypocardiac function

1. Impaired cardiac reserve
2. Arrhythmia
3. Cardiac ischemia
4.Pericardial effusion
5.Myocardial infarction

• Other factors

1. Bleeding
2. The hemolysis
3. Sepsis
4. Dialyzer reaction

How to prevent and cure dialysis low blood pressure

• Prevents effective blood volume from decreasing

Reasonable control of ultrafiltration, reassessment of patients’ target (dry) weight, increase of weekly dialysis time, using linear, gradient sodium curve mode dialysis.

• Prevention and treatment of improper dilatation of blood vessels

Reduce the temperature of dialysate antihypertensive drugs reduce or stop medication avoid eating during dialysis correct anemia rational use of autonomic nerve function drugs.

• Stabilize cardiac output

Active treatment of heart organic disease, cautious use of the heart has negative drugs.