Dialysis induced hypotension--a serious clinical problem in renal replacement therapy.

The occurrence of DIH is 15-30 or even 50% of dialysis sessions. There are three clinical patterns of DIH: acute, recurrent and chronic. Intradialytic hypotension essentially augments mortality due to hypoperfusion and concomitant damage of many vital organs, as well as due to chronic overhydration and inability to reach proper dry weight. The main causes of dialysis induced hypotension are age hypovolemia (rapid ultrafiltration), and coexisting decreases: autonomic neuropathy, cardiovascular diseases, diabetes. Therapeutic strategies include: patient education and perfect supervision by dialysis staff dialysis procedure-related methods (extension of dialysis duration, low dialysate temperature, sodium and ultrafiltration profiling and usage of biofeedback technique) and pharmacological treatment (e.g. midodrine, caffeine, vasopressin analogues). Proper treatment includes usage of invasive or cardiosurgical methods of heart failure which is a common reason of hypotension in the dialyzed population. Dialysis-induced hypotension is a very important, multifactorial clinical problem in dialysotherapy. Its incidence increases because of the growing number of elderly and diabetic patients in the dialyzed population.