The mechanism of intradialytic hypotension in diabetic patients.

Hemodynamic changes in diabetic patients were studied in both acetate and bicarbonate modes of hemodialysis (HD) where both body weight and plasma volume did not change. Diabetic patients showed a significant decrease in mean arterial pressure and cardiac output in both HD modes when compared to the predialysis values. Despite a decreased cardiac output, total peripheral vascular resistance did not increase, probably because of the sympathetic nerve dysfunction in diabetic patients. In addition, diabetic patients with acetate HD demonstrated peripheral vasodilation at a later stage of acetate HD. Increase in plasma acetate may have caused peripheral vasodilation in these patients. It is concluded that intradialytic hypotension in diabetic patients is mainly associated with a decrease in cardiac output and loss of compensatory increase in peripheral vascular tone.