Patient Positioning During a Hypotensive Episode for Adults Undergoing Hemodialysis: A Review of Clinical Effectiveness and Guidelines [Internet]

Renal disease affects one in ten Canadians with approximately 50,000 Canadians who received treatment for renal failure in 2019. In 2014, 20,690 Canadians were on dialysis costing approximately $1.9 billion annually. Dialysis is typically indicated for patients with end stage renal failure who have about 15% of renal function remaining. On average, patients receiving dialysis have a life expectancy of five to ten years unless they undergo kidney transplantation. By filtering waste and removing excess fluid from a patient’s blood, hemodialysis helps to maintain electrolyte balance and blood pressure. Nonetheless, hemodialysis may be associated with intradialytic complications such as nausea, vomiting, cramps, headache, itching, and hypotension.Intradialytic hypotension (IDH) is defined as a decrease of ≥20 millimetres of mercury (mm Hg) in systolic blood pressure or a decrease of ≥10 mm Hg in mean arterial pressure accompanied by clinical manifestations requiring intervention. IDH may be caused by cardiac factors, a reduction in fluid volume, and inability to vasoconstrict. Risk factors for IDH may include high body mass index, female sex, pre-dialysis systolic blood pressure 65 years, and comorbidities such as diabetes and ischemic heart disease. Strategies to help prevent recurrent episodes of IDH may include target weight reassessment, food avoidance during dialysis sessions, limiting sodium intake to minimize interdialytic weight gain, and using cool dialysate., During an acute episode of IDH, interventions may include slowing or stopping ultrafiltration, administering intravenous fluids and oxygen, and placing the patient in the Trendelenburg position where their feet are raised higher than their head. By promoting blood flow from the legs to the heart through gravity and increasing venous return, this patient position may help increase cardiac output and blood pressure.The aim of this report is to summarize and critically appraise the relevant clinical evidence and evidence-based guidelines regarding the effectiveness and use of Trendelenburg patient positioning during a hypotensive episode for adults undergoing hemodialysis.