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Intradialytic hypotension in an otherwise stable patient

Peter Kotanko, MD
William L Henrich, MD, MACP
Section Editor
Steve J Schwab, MD
Deputy Editor
Alice M Sheridan, MD


Hypotension during hemodialysis is common. In some patients, the development of hypotension necessitates intravenous fluid replacement before patients are able to safely leave the dialysis unit. Intradialytic hypotension may reduce the efficacy of the dialysis procedure and contributes to the excessive morbidity and mortality that is associated with hemodialysis.

This topic reviews the etiology, evaluation, treatment, and prevention of intradialytic hypotension in an otherwise stable patient. Other complications of hemodialysis are discussed elsewhere. (See "Acute complications during hemodialysis" and "Evaluation of sudden cardiac arrest and sudden cardiac death in dialysis patients".)

Hypertension during dialysis is discussed elsewhere. (See "Hypertension in dialysis patients", section on 'Hypertension during hemodialysis'.)


There is no generally accepted definition of intradialytic hypotension. Kidney Disease Outcomes Quality Initiative (KDOQI) and European Best Practice Guidelines define intradialytic hypotension as the presence of a decrease in systolic blood pressure ≥20 mmHg or a decrease in mean arterial pressure by 10 mmHg, providing the decrease in blood pressure is associated with clinical events and need for nursing interventions [1].


Symptomatic hypotension during (or immediately following) hemodialysis complicates 5 to 30 percent of all dialysis treatments [2,3]. In one study that included 44,801 dialysis treatments in 1137 patients, 75 percent of patients had at least one episode of intradialytic hypotension [2]. In some patients, more than 50 percent of treatments are complicated by intradialytic hypotension [4].

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Literature review current through: Nov 2017. | This topic last updated: Dec 13, 2017.
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