Dialysis hypotension: a review of recent studies of causative factors

Abstract

Dialysis hypotension is divided into two major categories. Intradialytic (dialysis-induced) hypotension is recognized during the dialysis session. The other recognized form is sustained or chronic hypotension continuing in the non-dialysis period. Intradialytic hypotension is caused mainly by an acute change in homeostasis due to dialysis therapy. Rapid ultrafiltration and changes in serum osmosis, electrolytes and temperature are considered major factors that cause intradialytic hypotension. Not only direct physical or chemical influences but also activation of humoral mediators play a role in this homeostasis during the haemodialysis (HD) session. Chronic hypotension is recognized in patients after dialysis initiation. Whether long-term chronic dialysis increases the incidence of persistent hypotension is not well documented; however, long-term chronic dialysis increases the incidence of cardiovascular disease. Pathology in the cardiovascular system, autonomic nervous system and humoral factors derived from chronic uraemia and repeated HD stimulation are considered to influence chronic hypotension. Dialysis hypotension is also reported as a mortality risk in chronic HD patients. This paper reviews recent studies examining the factors (Table1) that influence dialysis hypotension.