Abstract
Common causes of intradialytic hypotension include excessive ultrafiltration and/or use of antihypertensive medications prior to initiation of a hemodialysis treatment. An expanded differential diagnosis and evaluation may be required in cases of critically ill patients on hemodialysis – particularly those showing poor fluid responsiveness, elevation in lactate, or neurological changes. Care of the critically ill population mandates the need to be particularly aware of rare causes of intradialytic hypotension given preexistent malnutrition and accelerated clearance of water-soluble molecules as a result of renal replacement therapy.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Vantyghem MC, Douillard C, Balavoine AS. Hypotension from endocrine origin. Presse Med. 2012;41(11):1137–50. doi:10.1016/j.lpm.2012.03.023.
Ueda K, Takada D, Mii A, Tsuzuku Y, Saito SK, Kaneko T, et al. Severe thiamine deficiency resulted in Wernicke’s encephalopathy in a chronic dialysis patient. Clin Exp Nephrol. 2006;10(4):290–3. doi:10.1007/s10157-006-0440-9.
Barbara PG, Manuel B, Elisabetta M, Giorgio S, Fabio T, Valentina C, et al. The suddenly speechless florist on chronic dialysis: the unexpected threats of a flower shop? Diagnosis: dialysis related Wernicke encephalopathy. Nephrol Dial Transplant. 2006;21(1):223–5. doi:10.1093/ndt/gfh990.
Sequeira Lopes da Silva JT, Almaraz Velarde R, Olgado Ferrero F, Robles Marcos M, Perez Civantos D, Ramirez Moreno JM, et al. Wernicke’s encephalopathy induced by total parental nutrition. Nutr Hosp. 2010;25(6):1034–6. Epub 2011/04/27
Francini-Pesenti F, Brocadello F, Manara R, Santelli L, Laroni A, Caregaro L. Wernicke’s syndrome during parenteral feeding: not an unusual complication. Nutrition. 2009;25(2):142–6. doi:10.1016/j.nut.2008.08.003.
Hung SC, Hung SH, Tarng DC, Yang WC, Chen TW, Huang TP. Thiamine deficiency and unexplained encephalopathy in hemodialysis and peritoneal dialysis patients. Am J Kidney Dis Off J Natl Kidney Found. 2001;38(5):941–7. doi:10.1053/ajkd.2001.28578.
Descombes E, Dessibourg CA, Fellay G. Acute encephalopathy due to thiamine deficiency (Wernicke’s encephalopathy) in a chronic hemodialyzed patient: a case report. Clin Nephrol. 1991;35(4):171–5.
Dyckner T, Ek B, Nyhlin H, Wester PO. Aggravation of thiamine deficiency by magnesium depletion. A case report. Acta Med Scand. 1985;218(1):129–31.
Lynch KE, Feldman HI, Berlin JA, Flory J, Rowan CG, Brunelli SM. Effects of L-carnitine on dialysis-related hypotension and muscle cramps: a meta-analysis. Am J Kidney Dis. 2008;52(5):962–71. doi:10.1053/j.ajkd.2008.05.031. PMID: WOS:000260556000019
Andersen LW, Mackenhauer J, Roberts JC, Berg KM, Cocchi MN, Donnino MW. Etiology and therapeutic approach to elevated lactate levels. Mayo Clin Proc. 2013;88(10):1127–40. doi:10.1016/j.mayocp.2013.06.012. PMID: 24079682; PubMed Central PMCID: PMC3975915
Sadowski RH, Allred EN, Jabs K. Sodium modeling ameliorates intradialytic and interdialytic symptoms in young hemodialysis patients. J Am Soc Nephrol JASN. 1993;4(5):1192–8.
Hothi DK, Harvey E, Goia CM, Geary DF. Evaluating methods for improving ultrafiltration in pediatric hemodialysis. Pediatr Nephrol. 2008;23(4):631–8. doi:10.1007/s00467-007-0716-7.
Saran R, Bragg-Gresham JL, Levin NW, Twardowski ZJ, Wizemann V, Saito A, et al. Longer treatment time and slower ultrafiltration in hemodialysis: associations with reduced mortality in the DOPPS. Kidney Int. 2006;69(7):1222–8. doi:10.1038/sj.ki.5000186.
Hothi DK, Harvey E, Goia CM, Geary D. The value of sequential dialysis, mannitol and midodrine in managing children prone to dialysis failure. Pediatr Nephrol. 2009;24(8):1587–91. doi:10.1007/s00467-009-1151-8.
Lindholm T, Thysell H, Yamamoto Y, Forsberg B, Gullberg CA. Temperature and vascular stability in hemodialysis. Nephron. 1985;39(2):130–3.
Cruz DN, Mahnensmith RL, Brickel HM, Perazella MA. Midodrine and cool dialysate are effective therapies for symptomatic intradialytic hypotension. Am J Kidney Dis Off J Natl Kidney Found. 1999;33(5):920–6.
Selby NM, McIntyre CW. A systematic review of the clinical effects of reducing dialysate fluid temperature. Nephrol Dial Transplant. 2006;21(7):1883–98. doi:10.1093/ndt/gfl126.
Giacalone M, Martinelli R, Abramo A, Rubino A, Pavoni V, Iacconi P, et al. Rapid reversal of severe lactic acidosis after thiamine administration in critically ill adults: a report of 3 cases. Nutr Clin Pract. 2015;30(1):104–10. doi:10.1177/0884533614561790.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer International Publishing AG
About this chapter
Cite this chapter
Harshman, L.A., Alexander, S.R., Brophy, P.D. (2017). Intradialytic Hypotension: Potential Causes and Mediating Factors. In: Warady, B., Schaefer, F., Alexander, S. (eds) Pediatric Dialysis Case Studies. Springer, Cham. https://doi.org/10.1007/978-3-319-55147-0_19
Download citation
DOI: https://doi.org/10.1007/978-3-319-55147-0_19
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-55145-6
Online ISBN: 978-3-319-55147-0
eBook Packages: MedicineMedicine (R0)