Pediatric intradialytic hypotension: recommendations from the Pediatric Continuous Renal Replacement Therapy (PCRRT) Workgroup

  • Rupesh RainaEmail author
  • Stephanie Lam
  • Hershita Raheja
  • Vinod Krishnappa
  • Daljit Hothi
  • Andrew Davenport
  • Deepa Chand
  • Gaurav Kapur
  • Franz Schaefer
  • Sidharth Kumar Sethi
  • Mignon McCulloch
  • Arvind Bagga
  • Timothy Bunchman
  • Bradley A. Warady
Consensus Conference
Part of the following topical collections:
  1. What's New in Dialysis


Intradialytic hypotension (IDH) is a common adverse event resulting in premature interruption of hemodialysis, and consequently, inadequate fluid and solute removal. IDH occurs in response to the reduction in blood volume during ultrafiltration and subsequent poor compensatory mechanisms due to abnormal cardiac function or autonomic or baroreceptor failure. Pediatric patients are inherently at risk for IDH due to the added difficulty of determining and attaining an accurate dry weight. While frequent blood pressure monitoring, dialysate sodium profiling, ultrafiltration-guided blood volume monitoring, dialysate cooling, hemodiafiltration, and intradialytic mannitol and midodrine have been used to prevent IDH, they have not been extensively studied in pediatric population. Lack of large-scale studies on IDH in children makes it difficult to develop evidence-based management guidelines. Here, we aim to review IDH preventative strategies in the pediatric population and outlay recommendations from the Pediatric Continuous Renal Replacement Therapy (PCRRT) Workgroup. Without strong evidence in the literature, our recommendations from the expert panel reflect expert opinion and serve as a valuable guide.


Intradialytic hypotension Children Blood pressure monitoring Sodium profiling Blood volume monitoring Dialysate cooling Mannitol Midodrine 



We thank Ms. Jennifer Clark, Medical Writer, Akron Children’s Hospital for her assistance in language editing.

Funding information


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Supplementary material

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Appendix A (DOCX 14 kb)
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Appendix B (DOCX 13 kb)
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Appendix C (DOCX 13 kb)
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Appendix D (DOCX 14 kb)


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Copyright information

© IPNA 2019

Authors and Affiliations

  • Rupesh Raina
    • 1
    • 2
    Email author
  • Stephanie Lam
    • 3
  • Hershita Raheja
    • 4
  • Vinod Krishnappa
    • 2
    • 5
  • Daljit Hothi
    • 6
  • Andrew Davenport
    • 7
  • Deepa Chand
    • 8
  • Gaurav Kapur
    • 9
  • Franz Schaefer
    • 10
  • Sidharth Kumar Sethi
    • 11
  • Mignon McCulloch
    • 12
  • Arvind Bagga
    • 13
  • Timothy Bunchman
    • 14
  • Bradley A. Warady
    • 15
  1. 1.Department of NephrologyCleveland Clinic Akron General and Akron Children’s HospitalAkronUSA
  2. 2.Akron Nephrology Associates/Cleveland Clinic Akron GeneralAkronUSA
  3. 3.Department of PediatricsAkron Children’s HospitalAkronUSA
  4. 4.The Children’s Hospital of New JerseyNewark Beth Israel Medical CenterNewarkUSA
  5. 5.Northeast Ohio Medical UniversityRootstownUSA
  6. 6.Department of Paediatric NephrologyGreat Ormond Street HospitalLondonUK
  7. 7.UCL Centre for Nephrology, Royal Free HospitalUniversity College LondonLondonUK
  8. 8.Department of PediatricsWashington University School of MedicineSt. LouisUSA
  9. 9.Pediatric Nephrology and HypertensionChildren’s Hospital of MichiganDetroitUSA
  10. 10.Pediatric Nephrology Division, Center for Pediatrics and Adolescent MedicineHeidelberg University HospitalHeidelbergGermany
  11. 11.Pediatric Nephrology & Pediatric Kidney Transplantation, Kidney and Urology InstituteMedanta, The Medicity HospitalGurgaonIndia
  12. 12.Red Cross War Memorial Children’s HospitalUniversity of Cape TownCape TownSouth Africa
  13. 13.Division of Nephrology, Department of PediatricsAll India Institute of Medical SciencesNew DelhiIndia
  14. 14.Pediatric Nephrology & Transplantation, Children’s Hospital of RichmondVirginia Commonwealth UniversityRichmondUSA
  15. 15.Division of NephrologyChildren’s Mercy Kansas City, University of Missouri-Kansas City School of MedicineKansas CityUSA

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