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 etc. (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 sudden decrease in the mean arterial
pressure and are attributed to a decrease venous return and considered to be caused 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 issue 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, don't have a lot 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 staff who
treat patients know that sometimes the symptoms can be quiet subtle. Now, Why does
it happen? Well, normally staff will remove 2 to 4 litres...