Dialysis-associated hypotension: Difference between revisions
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==Background== | ==Background== | ||
*Most frequent complication of hemodialysis (20%-30% of | *Most frequent complication of hemodialysis (20%-30% of treatment) | ||
==Clinical Features== | ==Clinical Features== | ||
* | *[[Nausea/vomiting]] | ||
*Anxiety | *[[Anxiety]] | ||
*Dizziness | *[[Dizziness]] | ||
*Orthostatic hypotension | *Orthostatic [[hypotension]] | ||
*Syncope | *[[Syncope]] | ||
==Diagnosis== | ==Differential Diagnosis== | ||
*Excessive ultrafiltration | |||
**> 0.35 ml/min/kg | |||
**>20% plasma volume | |||
*Predialytic volume loss | |||
**GI losses (e.g. [[vomiting]], [[diarrhea]]) | |||
**Decreased oral intake | |||
*Intradialytic volume loss | |||
**Tube and hemodialyzer blood losses | |||
*Postdialytic volume loss | |||
**Vascular access blood loss | |||
*[[Hemorrhage]] | |||
*Medication effects | |||
**[[Antihypertensives]] | |||
**[[Opioids]] | |||
*Decreased vascular tone ([[sepsis]]) | |||
*Cardiac dysfunction | |||
**[[LVH]], [[myocardial ischemia|ischemia]], [[hypoxia]], [[arrhythmia]], pericardial [[tamponade]] | |||
*Pericardial disease | |||
**[[pericardial effusion|Effusion]] | |||
**[[Tamponade]] | |||
*[[Hemolytic anemia|Hemolysis]] | |||
== | {{Dialysis complications DDX}} | ||
==Evaluation== | |||
Assess: | |||
*Volume status (US) | |||
*Cardiac function | |||
*Pericardial disease | |||
*Infection | |||
*GI bleeding | |||
== | ===Evaluation by [[Hypotension]]Timing=== | ||
*Early in session: usually due to preexisting [[hypovolemia]] | |||
*During the session: often due to blood loss (from tubing or filter leak) | |||
*Near the end: usually result of excessive ultrafiltration | |||
**Underestimation of patient's ideal blood volume (dry weight) | |||
**Also consider pericardial or cardiac disease | |||
==Management== | ==Management== | ||
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==External Links== | ==External Links== | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category: | [[Category:Renal]] | ||
Latest revision as of 16:23, 16 October 2019
Background
- Most frequent complication of hemodialysis (20%-30% of treatment)
Clinical Features
- Nausea/vomiting
- Anxiety
- Dizziness
- Orthostatic hypotension
- Syncope
Differential Diagnosis
- Excessive ultrafiltration
- > 0.35 ml/min/kg
- >20% plasma volume
- Predialytic volume loss
- Intradialytic volume loss
- Tube and hemodialyzer blood losses
- Postdialytic volume loss
- Vascular access blood loss
- Hemorrhage
- Medication effects
- Decreased vascular tone (sepsis)
- Cardiac dysfunction
- LVH, ischemia, hypoxia, arrhythmia, pericardial tamponade
- Pericardial disease
- Hemolysis
Dialysis Complications
- Dialysis-associated hypotension
- Dialysis disequilibrium syndrome
- Air embolism
- Missed dialysis (pulmonary edema)
Evaluation
Assess:
- Volume status (US)
- Cardiac function
- Pericardial disease
- Infection
- GI bleeding
Evaluation by HypotensionTiming
- Early in session: usually due to preexisting hypovolemia
- During the session: often due to blood loss (from tubing or filter leak)
- Near the end: usually result of excessive ultrafiltration
- Underestimation of patient's ideal blood volume (dry weight)
- Also consider pericardial or cardiac disease