Intradialytic Hypotension in the Inpatient Setting for Patients on Long-Term Hemodialysis (HD)

Background: Intradialytic hypotension represents a complication that affects approximately 10-12% of hemodialysis treatments, but incidence also varied between 5-40%. It is characterized by a large drop in blood pressure during dialysis, defined as a systolic blood pressure decrease ≥20 mmHg or mean arterial pressure decrease ≥10 mmHg and may be accompanied by end-organ ischemia and requiring therapeutic intervention. IDH is associated with increased risk of cardiovascular mortality and overall mortality, myocardial stunning and cardiac dysfunction, cerebral ischemia and cognitive impairment, mesenteric ischemia and accelerated loss of residual renal function. Methods: At the inpatient dialysis center, each patient has recordings of their blood pressures during each dialysis treatment. We reviewed chronic HD patients who were admitted with an acute medical condition. Patients were excluded if they were first time hemodialysis patients or patients in the ICU. Recordings were reviewed for a two-week period from February 1, 2025 to February 14, 2025. There are comments written by the dialysis nurse and I reviewed to see if the patient had a drop in the BP, if so, if the patient was symptomatic, if dialysis had to be terminated, UF turned off and/or if there was any intervention (eg-Na modeling, administration of midodrine or any return of blood back to patient). Results: There was a total of 21 patients during the two-week period from 2/1/25-2/14/25. Of these patient encounters, there was a total of 91 sessions of HD during this time period. From these sessions, a total of 21 instances or 23% of the HD treatments had an episode of intradialytic hypotension. Conclusion: In the hospital setting, there is an increased amount of IDH episodes, which can be potentially due to patient’s clinical status, incorrect patient weight, bed scale not working or missing prescriptions. It is important to understand the reason the patient is in the hospital, what their dry weight is, obtaining outpatient records from their dialysis centers and making appropriate changes to the dialysis prescription to help prevent further episodes of intradialytic hypotension.