| Theme |
Hypertension and Hypotension in Patients with Maintenance Dialysis -- Mechanisms and Therapeutic Approach |
| Title |
Pathophysiology of intradialytic hypotension |
| Author |
Goichi Ogimoto |
Department of Medicine, Division of Hypertension and Nephrology, St.Marianna University School of Medicine |
| Author |
Tsutomu Sakurada |
Department of Medicine, Division of Hypertension and Nephrology, St.Marianna University School of Medicine |
| Author |
Mei Murao |
Department of Medicine, Division of Hypertension and Nephrology, St.Marianna University School of Medicine |
| Author |
Teruhiko Maeba |
Department of Medicine, Division of Hypertension and Nephrology, St.Marianna University School of Medicine |
| [ Summary ] |
Hypotension in chronic dialysis patients is consistent with sustained hypotension and intradialytic hypotension (IDH). IDH is one major complication in hemodialysis patients. Several factors are candidates for being the causes of this condition. They are : diabetes mellitus, left ventricular hypertrophy, ishchemic heart disease, advanced aged, and excessive body weight gain, etc. IDH is a condition which affects the quality of dialysis sessions because of inadequate ultrafiltration volume, reduced blood flow and/or shortened therapy time. Pathophysiological factors related to IDH are summarized as follows: (1) rapid decrease of circulation volume, (2) autonomic nerve dysfunction, (3) absence of decreased venous capacity and/or increased vascular resistance, (4) impaired cardiac function, (5) influence of plasma vasoactive hormones, and (6) effect of anti-hypertensive agents. Vasoactive hormones, especially affect autonomic dysfunction and may induce the sudden onset of hypotension. |