Dialysis-associated hypotension: Difference between revisions
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==Background== | ==Background== | ||
*Most frequent complication of hemodialysis (20%-30% of tx) | *Most frequent complication of hemodialysis (20%-30% of tx) | ||
==Clinical Features== | ==Clinical Features== | ||
* | *[[Nausea/vomiting]] | ||
*Anxiety | *Anxiety | ||
*Dizziness | *Dizziness | ||
*Orthostatic hypotension | *Orthostatic hypotension | ||
*Syncope | *[[Syncope]] | ||
==Diagnosis== | ==Differential Diagnosis== | ||
*Excessive ultrafiltration | |||
*Predialytic volume loss | |||
**GI losses | |||
**Decreased oral intake | |||
*Intradialytic volume loss | |||
**Tube and hemodialyzer blood losses | |||
*Postdialytic volume loss | |||
**Vascular access blood loss | |||
*Medication effects | |||
**Antihypertensives | |||
**Opiates | |||
*Decreased vascular tone (sepsis) | |||
*Cardiac dysfunction | |||
**LVH, ischemia, hypoxia, arrhythmia, pericardial tamponade | |||
*Pericardial disease | |||
**Effusion | |||
**Tamponade | |||
{{Dialysis complications DDX}} | {{Dialysis complications DDX}} | ||
== | ==Diagnosis== | ||
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 pt'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:Nephro]] | [[Category:Nephro]] | ||
Revision as of 13:31, 28 June 2015
Background
- Most frequent complication of hemodialysis (20%-30% of tx)
Clinical Features
- Nausea/vomiting
- Anxiety
- Dizziness
- Orthostatic hypotension
- Syncope
Differential Diagnosis
- Excessive ultrafiltration
- Predialytic volume loss
- GI losses
- Decreased oral intake
- Intradialytic volume loss
- Tube and hemodialyzer blood losses
- Postdialytic volume loss
- Vascular access blood loss
- Medication effects
- Antihypertensives
- Opiates
- Decreased vascular tone (sepsis)
- Cardiac dysfunction
- LVH, ischemia, hypoxia, arrhythmia, pericardial tamponade
- Pericardial disease
- Effusion
- Tamponade
Dialysis Complications
- Dialysis-associated hypotension
- Dialysis disequilibrium syndrome
- Air embolism
- Missed dialysis (pulmonary edema)
Diagnosis
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 pt's ideal blood volume (dry weight)
- Also consider pericardial or cardiac disease