Intradialytic Hypotension: Potential Causes and Mediating Factors

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.