Low Blood Pressure and Hemodialysis

Answer 1

Hemodialysis is one of the most widely used kidney replacement therapies for people that suffer from kidney failure. It is estimated that there are over a quarter of a million people on hemodialysis in this country. One of the most common complications from hemodialysis is low blood pressure. Having low blood pressure can make a person dizzy, fatigued, and nauseous after a dialysis treatment, greatly diminishing their quality of life. Up to 50% of all patients on hemodialysis suffer from low blood pressure as a direct result of the dialysis process. Medication and treatment for low blood pressure after a hemodialysis session may or may not help to alleviate the symptoms.

Although hypotension may be a symptom of a serious medical condition like a heart attack, shock, sepsis, or loss of blood volume, it is more often the result of other contributing factors that interfere with the dialysis treatment. For example, a person that eats before a dialysis session is at a greater risk for suffering symptoms of hypotension. When a person eats food, the body rushes blood to the digestive organs. As the dialysis session commences, the dialysis machine draws out blood to be filtered, lowering blood pressure and reducing flow to certain organs and areas of the body. This can contribute to low blood pressure. Most dialysis patients are advised to refrain from eating before dialyzing for this reason.

Another source of low blood pressure in hemodialysis patients is a reaction to the membrane used in the dialysis treatment. Approximately 5% of patients that suffer from low blood pressure can attribute their symptoms to a bad reaction to the membrane. In order to solve this problem, nephrologists and dialysis nurses can change the kind of membrane used during treatment.

During the dialysis treatment, the nephrologist can decide how much fluid to remove from the patient during one session. If too much fluid is drawn out or if it is removed too quickly, low blood pressure can result. For this reason, it's important that physicians estimate a patient's dry weight accurately and regularly. Unfortunately, estimating dry weight still involves a lot of guess work, which makes it difficult.

Finally, it is important for nephrologists to prescribe the correct level of sodium concentration in the dialysis fluid. Having a higher concentration of sodium in the fluid can lessen the chances that the patient will develop symptoms of low blood pressure.