Ten tips for how to prevent and treat hemodynamic instability during hemodialysis.
9 affiliations
- 1Medical University of Vienna, Department of Medicine III, Division for Nephrology & Dialysis, Vienna, Austria.
- 22nd Department of Nephrology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
- 3Medical University of Graz, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Division of Physiology & Pathophysiology, Graz, Austria.
- 4Center for Medical Science, University of Trento, Trento, Italy.
- 5Multidistrict Nephrology and Dialysis Unit, ASUIT, Trento, Italy.
- 6Bordeaux School of Public Health, Université de Bordeaux, INSERM U1219, CIC 1401, Bordeaux, France.
- 7Department of Nephrology and Nutrition, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France.
- 8Centre Hospitalier d'Ardèche Méridionale, Aubenas, France.
- 9Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Abstract
Intradialytic hypotension (IDH) is a frequent complication of hemodialysis that may occur with symptoms and often requires interventions to restore hemodynamic stability and end-organ perfusion. In the absence of large trials with IDH as the primary endpoint, guidelines recommending specific management protocols are not available, but hemodynamic instability is a daily clinical reality, nevertheless. First, we suggest defining and monitoring IDH, by adopting a uniform IDH definition such as the Nadir90 criteria and document symptoms, and regularly measuring intradialytic as well as ambulatory blood pressure. Next, we give recommendations on how to treat IDH, by developing a standard operating procedure for acute events, and increasing dialysate sodium, and decreasing ultrafiltration rates and dialysate temperature. Finally, the majority of our tips are dedicated to preventing IDH, by regularly assessing fluid status, reviewing antihypertensive drugs, considering more frequent, longer or nocturnal dialysis, potentially considering hemodiafiltration, avoiding food and considering exercise, and trying automatic feedback algorithms. No single measure consistently prevents IDH, and each tip should be viewed as one lever among many. In practice, IDH is best managed by a layered, individualized approach that combines rigorous documentation, structured follow-up and a willingness to revisit the prescription each time hemodynamic instability recurs.
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BibTeX
@article{mussnig2026tips,
title = {{Ten tips for how to prevent and treat hemodynamic instability during hemodialysis.}},
author = {Sebastian Mussnig and Panagiotis I Georgianos and Manfred Hecking and Daniel Schneditz and Yuri Battaglia and Christian Combe and Vassilios Liakopoulos and Casper Franssen},
journal = {Clinical kidney journal},
year = {2026},
month = oct,
doi = {10.1093/ckj/sfag358},
url = {https://europepmc.org/article/MED/43011563},
note = {CC BY},
}
RIS
TY - JOUR
TI - Ten tips for how to prevent and treat hemodynamic instability during hemodialysis.
AU - Sebastian Mussnig
AU - Panagiotis I Georgianos
AU - Manfred Hecking
AU - Daniel Schneditz
AU - Yuri Battaglia
AU - Christian Combe
AU - Vassilios Liakopoulos
AU - Casper Franssen
PY - 2026
DA - 2026/10/08
JO - Clinical kidney journal
DO - 10.1093/ckj/sfag358
UR - https://europepmc.org/article/MED/43011563
AB - Intradialytic hypotension (IDH) is a frequent complication of hemodialysis that may occur with symptoms and often requires interventions to restore hemodynamic stability and end-organ perfusion. In the absence of large trials with IDH as the primary endpoint, guidelines recommending specific management protocols are not available, but hemodynamic instability is a daily clinical reality, nevertheless. First, we suggest defining and monitoring IDH, by adopting a uniform IDH definition such as the Nadir90 criteria and document symptoms, and regularly measuring intradialytic as well as ambulatory blood pressure. Next, we give recommendations on how to treat IDH, by developing a standard operating procedure for acute events, and increasing dialysate sodium, and decreasing ultrafiltration rates and dialysate temperature. Finally, the majority of our tips are dedicated to preventing IDH, by regularly assessing fluid status, reviewing antihypertensive drugs, considering more frequent, longer or nocturnal dialysis, potentially considering hemodiafiltration, avoiding food and considering exercise, and trying automatic feedback algorithms. No single measure consistently prevents IDH, and each tip should be viewed as one lever among many. In practice, IDH is best managed by a layered, individualized approach that combines rigorous documentation, structured follow-up and a willingness to revisit the prescription each time hemodynamic instability recurs.
SN - 2048-8505
SN - 2048-8513
ER -