Prevention of Hypotension During Dialysis.

Hypotension during dialysis is a common complication in haemodialysis patients,

which typically occurs during the later stages of dialysis. It is estimated that

hypotension occurs 25 to 50% of dialysis treatments (Victor and Henrich 1994 pg196-

208). Many factors involve in hypotension during dialysis including volume

depletion, high ultrafiltration rate, autonomic dysfunction, antihypertensive

medications, bioincompatible dialyser membrane, low dialysate temperature,

declining serum osmolarity and so on (Daugirdas 1991 pg 233). However, in spite of

appropriate treatment, many patients still suffer from hypotension during

haemodialysis. Collins et al (1990) when hypotension occurred the cardiac output

drops sharply and there were concomitant abrupt lower in the mean arterial

pressure and are attributed to a decrease venous return and considered to be ca implementd by

relocation of circulating blood, possible associated a sudden decrease in venous tone

which will result in hypotension. The etiology and prevention of intradialytic

hypotension has become an increasingly complex step to the fore and the volume depletion due

to ultrafiltration remains the predominant underlying etiologic factor, Sherman et al

(2002).

I remembered I had one patient, and many of the patients as you

know, dont have a mint of symptoms. He was telling that he was feeling good and that

and that everything was getting worse in his face.



I took his blood pressure and it was

70/40 mmHg but the patient had none of the typical symptoms of hypotension like

vomiting, dizziness, headache etc. (Ramsy et al 1999) defined hypotension of

blood pressure lower than 90/60 mmHg and varies from persons age, time of

recording and different sphygmomanometer, and the way different people use the

equipment can give different readings and individual tolerance. Most of the round who

treat patients know that sometimes the symptoms can be quiet subtle. Now, wherefore does

it happen? Well, normally staff will remove 2 to 4 litres...

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