医学
重症监护医学
透析
血液透析
不利影响
血管内容积状态
血流动力学
心脏病学
内科学
作者
Patrick Reeves,Finnian R. Mc Causland
出处
期刊:Clinical Journal of The American Society of Nephrology
[American Society of Nephrology]
日期:2018-02-26
卷期号:13 (8): 1297-1303
被引量:130
摘要
Individuals with ESKD requiring maintenance hemodialysis face a unique hemodynamic challenge, typically on a thrice-weekly basis. In an effort to achieve some degree of euvolemia, ultrafiltration goals often involve removal of the equivalent of an entire plasma volume. Maintenance of adequate end-organ perfusion in this setting is dependent on the institution of a variety of complex compensatory mechanisms. Unfortunately, secondary to a myriad of patient- and dialysis-related factors, this compensation often falls short and results in intradialytic hypotension. Physicians and patients have developed a greater appreciation for the breadth of adverse outcomes associated with intradialytic hypotension, including higher cardiovascular and all-cause mortality. In this review, we summarize the evidence for adverse outcomes associated with intradialytic hypotension, explore the underlying pathophysiology, and use this as a basis to introduce potential strategies for its prevention and treatment.
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