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Intradialytic Hypotension — ESENeph MCQ

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ModerateHaemodialysisIntradialytic HypotensionESENeph

A 68-year-old woman on haemodialysis develops persistent hypotension during sessions (BP drops to 80/50 mmHg). She is dialysing at 35°C dialysate temperature, with a dry weight of 62 kg and ultrafiltration rate of 13 mL/kg/hr. What is the most appropriate initial intervention?

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Correct answer: A — Reduce ultrafiltration rate and reassess dry weight

Intradialytic hypotension (IDH) is the most common acute complication of haemodialysis. The ultrafiltration rate should ideally be <13 mL/kg/hr (KDOQI recommendation). Reassessing dry weight is crucial as it may be set too low. Cool dialysate (35-36°C) is already being used (evidence-based intervention). Increasing dialysate temperature would worsen hypotension. Midodrine is a second-line option. Routine saline boluses are not recommended as they counteract fluid removal.

Reference: ERA-EDTA 2019 – Intradialytic Hypotension Guideline; KDOQI 2015 – HD Adequacy