2. • Intradialytic hypotension (IDH) is a frequent and serious complication of
chronic HD
• Prevalence of IDH range between 8-40%.
• 75% of all patients have had at least 1 episode in a study
• Associated with long-term outcomes including increased cardiovascular
events and mortality from all causes
3. • Nama : Tn . BMB
• Tgl Lahir : 09 Mei 1971
• Usia : 52 th
• Alamat : Jl. Maharta VI Pondok Aren,
Jakarta utara
• Status pernikahan: Menikah
• Pekerjaan : Pegawai swasta
• Pembiayaan: JKN
4. • Demam dan menggigil saat hemodialisis disertai ada nanah di sekitar
kateter double lumen.
5. Riwayat penyakit sekarang
• Pasien terdiagnosis hipertensi di klinik,
mendapat terapi amlodipine 5 mg 1x1, minum
obat hanya sekitar 1 minggu dan berhenti
sendiri karena merasa tidak ada keluhan lagi
• September, pasien mengeluh pusing dan
vertigo berobat ke klinik , dokter praktek tetapi
tidak ada perubahan. Kemudian pasien berobat
di poli RS ANTAM dianjurkan pemeriksaan lab
dan USG dan didapatkan fungsi ginjal sisa 7 %
dan hasil USG kista multiple kedua ginjal. Saat
itu pasien sudah disarankan untuk terapi
pengganti ginjal tetapi pasien masih menolak
karena BAK masih banyak (1000 cc sehari)
• Desember, pasien kontrol Kembali ke poliklinik
di RS ANTAM, dikatakan fungsi ginjal membaik
sehingga pasien menunda untuk tindakan
terapi pengganti ginjal,
• Januari , Pasien mengalami kecelalakan (jatuh
dari motor), selama ini pasien kadang
berkendaraan motor Jakarta– BSD untuk
keperluan bisnis, dilakukan pemeriksaan
roentgen didapatkan hasil ada retak di tulang
kering kaki kiri. Dokter tidak menganjurkan
untuk tindakan operasi, tetapi hanya minum
obat anti nyeri saja.
• Februari, masuk RSCM dengan keluhan mual
muntah, setiap makan dan minum, disertai
keluhan lemas, pasien dilakukan Hemodialisis
pertama kali, dipasang akses CDL pada IVJ
dextra. dan melanjutkan HD rutin di RS Kartika
pulomas
• Pasien rutin menjalani HD 2 x seminggu,
• Pasien mendapat tranfusi 4 kantong PRC karena
Hb rendah
• HD terakhir tidak tuntas, karena pasien
menggigil dan demam saat jam ke 2 sehingga
dirujuk ke RSCM
2018 2022 2023
Saat Ini
6. • Riwayat penyakit keluarga
• Ayah pasien menderita HT, Ibu pasien memiliki asam urat tinggi, saudara
pasien (adiknya) meninggal karena sakit jantung, tidak ada riwayat keluarga
memiliki penyakit ginjal, penyakit paru,liver atau keganasan.
• Riwayat biopsikososial
• Pasien merupakan pegawai swasta , telah menikah
• Tinggal dengan istri, 3 orang anak kandung
• Berobat dengan menggunakan penjaminan JKN
7. Mata konjungtiva pucat, sklera anikterik
Leher JVP 5-2 cmH2O, KGB dan tiroid tidak membesar,
luka bekas aff CDL jugular dextra bersih,
Paru : bunyi napas vesikuler, tidak didapatkan
ronkhi dan wheezing pada kedua lapangan paru
Jantung BJ I dan II reguler, tidak ada murmur/gallop
Abdomen datar, lemas, BU positif normal, nyeri
tekan negatif, tidak ada pembesaran hepar/lien,
Ekstremitas akral hangat, tidak edema,akses cdl
femoral sinistra, CRT <2”
Compos mentis
TD 128/84 mmHg
FN 78 x/menit
Suhu 37,4oC
RR 17 x/menit
SaO2 99% room air
BB 61 kg ( pre HD)
BB post HD: 53 kg
BBK: 52 kg
TB 163 cm
IMT 20,7 kg/m2
9. Test Nilai Rujukan Unit 22/04/22 11/1/23
Natrium (Na)
Darah
136 - 145 mEq/L 134 136
Kalium (K)
Darah
3.5 - 5.1 mEq/L 3,3 4,4
Klorida (Cl)
Darah
98.0 - 107.0 mEq/L 101.4 102,2
Fosfat
Inorganik(P)
Darah
2.3 - 4.7 mg/dL 3.8 5,3
Magnesium
(Mg) Darah
1.60 - 2.60 mg/dL 1.6 1,8
Kalsium (Ca++)
Ion
1.01 - 1.31 mml/L 1.09 -
Test
Nilai
Rujukan
Unit 24/04/22 11/1/23
Albumin 3.50 - 5.20 g/dL 3.10 3,5
Asam Urat 2.6 - 6 mg/dL 7.5 6.4
Glukosa Darah 60 - 140 mg/dL 117 198
HbA1c % 8.5 -
Ureum 18 - 55 mg/dL 71.4 205.4
Kreatinin (e-GFR) 0.73 – 1.18 mg/dL 4.6 (10.2) 7,9 (5,2)
GOT 5- 34 U/L 27 35
GPT 0 – 55 U/L 6 10
Fe 50 - 170 ug/dL 41 78
TIBC 228 – 428 ug/dL 219 209
Ferritin 20 - 200 Ng/mL 119,77 234,01
10. Irama Sinus, 75 bpm, normo-aksis, gelb P normal,
PR Interval 0,16s, QRS 0,08s, ST-T Changes neg, tidak ada VH/BBB, Kesimpulan :
Kardiomegali dengan elongasi aorta
11. Pre HD Jam 1 Jam 2 Jam 3 Jam 4 Jam 5 Post HD
IDWG 4 kg
BB 57 kg 53.5 Kg
Keluhan - - - - Pusing,lemas, -
Tek darah 187/95 179/83 165/73 145/77 85/45 121/46 130 /80
Qb - 250 250 250 150 200
Qd 500 500 500 500 500
Suhu 36.5 36.5 36.5 36.5 36.5 36.5
TMP 40 40 39 43 40
Tekanan
vena
172 171 175 178 120
Vol yang
ditarik
UFG ↓ 3500
Intervensi - - - - Tredelenberg,
Nacl 0.9% 100 • Kt/V 1.7
12. Pre HD Jam 1 Jam 2 Jam 3 Jam 4 Jam 5 Post HD
IDWG 4.5 kg
BB 58 kg 54.5 Kg
Keluhan - - - - pusing -
Tek darah 183/91 178/79 160/73 146/76 86/45 120/44 139 /80
Qb - 250 250 250 150 200
Qd 500 500 500 500 500
Suhu 36.5 36.5 36.5 36.5 36.5 36.5
TMP 40 40 39 43 40
Tekanan
vena
172 176 185 178 100
Vol yang
ditarik
UFG ↓ 3500
Intervensi - - - - Tredelenberg,
Nacl 0.9% 100
Nacl 0.9%
100 cc • Kt/V 1.8
13. Pre HD Jam 1 Jam 2 Jam 3 Jam 4 Jam 5 Post HD
IDWG 3.5 kg
BB 58 kg 54.5 Kg
Keluhan - - - - pusing lemas -
Tek darah 163/81 148/79 150/73 146/76 78/46 89/50 139 /80
Qb - 250 250 250 150 150
Qd 500 500 500 500 500
Suhu 36.5 36.5 36.5 36.5 36.5 36.5
TMP 40 40 39 43 40
Tekanan
vena
172 176 185 178 100
Vol yang
ditarik
UFG ↓ 3500
Intervensi - - - - Tredelenberg,
Nacl 0.9% 100
terminasi
• Kt/V 1.9
14. Pre HD Jam 1 Jam 2 Jam 3 Jam 4 Jam 5 Post HD
IDWG 5 kg
BB 59,5 kg 55.5 Kg
Keluhan - - - - pusing lemas -
Tek darah 173/81 158/79 150/73 146/76 98/50 87/50 139 /80
Qb - 250 250 250 150 150
Qd 500 500 500 500 500
Suhu 36.5 36.5 36.5 36.5 36.5 36.5
TMP 40 40 39 43 40
Tekanan
vena
172 176 185 178 100
Vol yang
ditarik
UFG ↓ 4000
Intervensi - - - - Tredelenberg,
Nacl 0.9% 100
terminasi
• Kt/V 1.9
15. CKD 5 on HD
Hipotensi Intradialitik
Anemia Normositik Normokrom ec Anemia renal dd/ anemia perdarahan ?
1.DM tipe 2 Non obese dengan insulin
1.HHD
16. Non Farmakologi
• Diet protein 1.2 gr/kgbb/hr
• Diet DM 1700 kkal/hari
• Diet rendah garam
• Hemodialisis 2 x seminggu
Farmakologi
• Candesartan 1 x 16 mg
• Adalat oros 2x30 mg
• Clonidine 2 x 0.15 mg
• Gliquidone 2x 15 mg,
• Lantus 0-0-10
• As folat 1 x 5 mg
• Caco3 3x500 mg
• Bicnat 3 x 500 mg
• Eritropoetin 2x3000 IU
17. Daftar Masalah Pengkajian Target Tatalaksana
HIPOTENSI
INTRADIALITIK
Dalam 1 bulan terakhir saat HD terjadi penurunan
tekanan darah pada jam ketiga dan keempat. Disertai
pusing dan mual. Pasien makan besar 1 jam pertama
sesi HD. Pasien minum obat tekanan darah tidak teratur
Pemeriksaan fisik:
Pemantauan HD terjadi penurunan tekanan sistolik <90
mmHg atau MAP>20 mmHg disertai dengan symptom
BBK 52 kg; BB post HD: 54 kg
IDWG 3-5 kg
UF 3000-5000 ml
Dipikirkan Intradialytic hypotension e.c IDWG berlebih
dd/ resistensi splanchnic
• Tercapainya
kestabilan
hemodinamik
intradialytic
dengan fluktuasi
penurunan TDS
<20%
• Kenaikan BB
tidak melebihi
target IDWG
Rencana Diagnosis
Echocardiografi
Rencana Evaluasi
-
Rencana Terapi
Non farmakologis
Evaluasi tekanan darah intradialytic
Candesartan 1x16 mg
Adalat oros 2x30 mg
Clonidine distop
Edukasi
• Pembatasan asupan garam < 2gr/hr
• Pembatasan minum
• IDWG <3 kg
• Tidak makan besar saat sesi HD
18. Daftar Masalah Pengkajian Target Tatalaksana
CKD 5 HD Riwayat didiagnosis penyakit ginjal kronis sejak 2 tahun yang
lalu, dan mulai menjalani hemodialisis sejak 2020,
DM (+) sejak 2005 tidak terkontrol HT (+) sejak 2005 tidak
terkontrol
Riw. Peny. Keluarga HT (+) DM, Ginjal, Jantung tidak diketahui
Pemeriksaan Fisik
BP 180/90mmHg
Mata: konjungtiva pucat, sklera anikterik,
edema preorbital tidak ada
Abdomen: supel, BU(+) normal, tidak ada nyeri tekan, tidak
teraba hepar/lien, shifting dullness negative
Ekstremitas; akral hangat, CRT<2s,
Pemeriksaan Penunjang
11/01/2023
Hb 8,9
Ur/Cr/eGFR : 205/7,9/ 5,2
USG : sesuai gambaran penyakit ginjal kronis
Dipikirkan
CKD Stage V ec nefropathy diabetic dd/ nefropati hipertensi
dengan komplikasi anemia
• Adekuasi HD
tercapai :
• Kt/V> 1.8
• Intake baik
• Hb 10 – 12 gr/dl
• Albumin 3.5-5.0 g/dL
• Phosphor 3.5-5.5
mg/dL
Rencana Diagnosis
(-)
Rencana Evaluasi
ACR, Ur/Cr Elektrolit / bulan
Rencana Terapi
Non farmakologis
• Diet biasa 1700 kkal, garam<2gram per hari,
protein 1.2 gr /kgBB/hari = 63 gr/hari
Farmakologis
• Asam folat 3x1
• Cac03 3x1
• Bicnat 3x500
Edukasi
- Mengenai etiologi, terapi, komplikasi
penyakit
- Tanda dan kegawatan pada CKD
19. Daftar Masalah Pengkajian Target Tatalaksana
ANEMIA
NORMOSITIK
NORMOKROM
Pasien di diagnosis CKD sejak 2020, dan rutin
menjalani hemodialisis, pasien memiliki riwayat
opname dengan diagnosis stress ulcer,
Pemeriksaan Fisik
BP 180/90mmHg
Konjungtiva anemis (+)
Jantung: BJ 1 2 regular, tidak ada murmur/gallop,
kesan kardiomegali
Ekstremitas; akral hangat, CRT<2s,
Pemeriksaan Penunjang
Hb 8,9 gr/dl
MCV 83,5
MCH 26.1
SI 78
TIBC 209
Saturasi tranferin 37
Ferritin 234
Dipikirkan
Anemia normositik normokrom ec anemia renal dd/
occult bleeding
Hb 10 – 12 gr/dl
Konfirmasi : FOBT
Rencana Diagnosis
• Darah rutin serial
• Profil Besi (SI, TIBC, Feritin) berkala
• FOBT
Rencana Terapi
• Epoetin alfa 2 x 3000 sc/minggu
Edukasi
• Menjelaskan kepada pasien penyakit, terapi dan
komplikasi
20. Daftar Masalah Pengkajian Target Tatalaksana
Hipertensi
Heart Disease
(HHD)
Pasien terdiagnosis HT sejak 2005, awalnya
berobat dengan captopril, terapi tidak teratur,
Riw. Peny. Keluarga HT (+); DM (+), Ginjal, Jantung
tidak diketahui
Pemeriksaan Fisik
BP 180/90mmHg
Jantung: BJ 1 2 regular, tidak ada murmur/gallop,
kesan kardiomegali
Ekstremitas; akral hangat, CRT<2s,
Pemeriksaan Penunjang
EKG
Irama Sinus, 75 bpm, normo-aksis, gelb P normal,
PR Interval 0,16s, QRS 0,08s, ST-T Changes neg,
tidak ada VH/BBB
CXR :
Kardiomegali dengan elongasi aorta
Dipikirkan
HHD
Hipertensi primer dd. Sekunder pada CKD Stage V
BP < 130/80 sesuai
toleransi
Rencana Diagnosis
Pertimbangan echocardiography oleh IPD Kardio
EKG
Pemeriksaan profil lipid
Rencana Evaluasi
Pemeriksaan BP mandiri
Rencana Terapi
Non farmakologis
Diet rendah garam < 2 gram per hari,
Farmakologis
Po Adalat Oros 2x30 mg
Po Candesartan 1x16 mg
Po Clonidin 2 x 0,15 mg
Po Bisoprolol 1 x2,5 mg
Edukasi
• Edukasi diet rendah garam dan pembatasan
cairan oral
• Tanda dan kegawatan pada hipertensi
21. Daftar Masalah Pengkajian Target Tatalaksana
DMT2 Pasien terdiagnosis DM sejak 2005, awalnya
berobat dengan glibenklamide, tetapi berhenti
sendiri, Rwi, Pengobatan. DM tidak teratur, saat ini
menggunakan Po Glukuidon 2x15 mg , SK Lantus
1x10 Unit
Pemeriksaan Fisik
BB: 53 Kg TB 160 cm IMT 20,7kg/m2
Pemeriksaan penunjang
11/01/2023
GDS 198
Ur/Cr/eGFR : 205/7,9/ 5,2
Dipikirkan:
DMT2, Normoweight, Regulasi GD terkontrol,
dengan Insulin dengan nefropati DM
GDP : 80-100 mg/dL
GDS 140-180 mg/dL
Rencana Diagnosis
• Evaluasi GDP dan GD2jpp, A1C /3 bln
• Echocardiografi
• EKG
• Pemeriksaan profil lipid
Rencana Evaluasi
• Kontrol Endokrin
Rencana Terapi
Non farmakologis
Diet DM 1700 kkal/hari
Farmakologis
Gliquidone 2 x15 mg
SK Lantus 1x10 Unit
Edukasi
• Edukasi intake yang sesuai kebutuhan
• Edukasi aktifitas fisik yang sesuai
• Tanda dan kegawatan pada DM :
hipoglikemia, hiperglikemia
24. • 75% of all patients have had at least 1 episode in a study (Daugirdas, 1991;
Degoulet, 1991)
• Occurs in 5-30% of all dialysis treatment
• In some patients, 50% of treatments are affected
• Older patients
• Longer dialysis vintage
• Diabetes
• Low pre dialysis blood pressure
• Higher UF goal
25. • Cardiac stunning: Echo during dialysis confirms the presence of LV
regional wall motion abnormality (Chesterton. Hemodialysis Int. 2010)
• Episodic IDH exacerbate evolving myocardial injury
• Gut Stunning: Non occlusive mesenteric ischemia is associated with
frequent IDH (Daugirdas. AJKD. 2001)
• Mesenteric ischemia allow bacterial endotoxins to enter the circulation,
causing vasodilatation and reduced cardiac contractility (McIntyre. Seminars in
Dialysis. 2010)
26. • AVF thrombosis rate is higher with IDH
• In patients with IDH>30% of all had 2x risk of AVF thrombosis
• Substandard dialysis treatment
• Negative perception of Dialysis
27. K/DOQI Workgroup. K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis. 2005 Apr;45(4 Suppl 3):S1-153
Kooman J, Basci A et al. EBPG guideline on haemodynamic instability. Nephrol DialTransplant. 2007 May;22 Suppl 2:ii22-44.
• Penyebab paling dominan: volume sirkulasi darah berkurang agresif
akibat ultrafiltrasi,
• Perubahan osmolalitas ekstraseluler perpindahan sodium, dan
ketidakseimbangan antara ultrafiltrasi dan plasma refilling.
• Ketidakmampuan sistem kardiovaskuler dalam merespon penurunan
volume darah secara adekuat, (reflek aktivasi simpatik: takikardi dan
vasokonstriksi)
28. Intradialytic Hypotension cause
• Wang K. Renalfellow.org. 2019
• Daugirdas JT, Blake PG, Ing TS. Handbook of Dialysis. 5th ed. 2015
Meal ingestion
Inaccurate EDW
Antihypertensive med
Anemia
Dialysate temperature
29. Potential mechanisms underlying the ultrafiltration rate and adverse
outcome associations.
Assimon, Flythe J. , Rapid ultrafiltration rates and outcomes among
hemodialysis patients: re-examining the evidence base. CJASN. 2015
CaseIDWG rata rata 3-5kg
Casetime 4-5 h
Kt/v 1.7
30. Faktor dan konsekuensi abnormalitas tekanan darah dan volume selama HD
Flythe JE, Chang TI, Gallagher MP, Lindley E, Madero M, Sarafidis PA, Unruh ML, Wang AY, Weiner DE, Cheung M, Jadoul M, Winkelmayer WC, Polkinghorne KR; Conference Participants.
Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2020 May;97(5):861-
876.
31. Sherman RA et al. AJKD. 1988
45 minutes following an intradialytic
meal, mean BP fell 14.4 mm Hg/h.
And the effect continue until 2 hours after meal
During hypovolemia, the body attempts to conserve blood flow to vital organs, limiting
flow to the splanchnic and other circulations. Feeding a patient during a dialysis session
upsets these conservation measures because feeding results in an obligatory increase in
splanchnic blood flow with splanchnic blood pooling and decreased venous return.
Meal in dialysis session
Postprandial blood pressure changes during Haemodialysis
32. • Jelicic I. Relationship of a food intake during hemodialysis and symptomatic intradialytic hypotension. Hemodia Int. 2021
Fasting during hemodialysis
may cause significantly
lower frequency of
intradialytic hypotension
and cramping without
affecting the nutritional
status
Edukasi mengenai
pembatasan makanan
saat HD terutama pada
pasien dengan Riwayat
IDH
34. K/DOQI 2005 Clinical Practice Guidelines for Cardiovascular disease in
Dialysis patient
• Antihypertensive drugs should be given preferentially at night,
because it may reduce the nocturnal surge of blood pressure and
minimize intradialytic hypotension, which may occur when drugs
are taken the morning before a dialysis session. (grade C)
35. • 2630 patients
• There was no difference in IDH
frequency between patients who
held vs those who continued taking
their meds prior to HD treatment.
Davenport A et al. Kidney Int. 2008
Percentage of patients developing intradialytic hypotension prescribed different class antihypertensive
med and also those who were prescribed no antihypertensive medications (none).
36. UF rate
3762 patients in 1.5 years
UFR> 13 ml/kg/h was potently and
significantly associated with a greater
hazard for outcome
Flythe J. Rapid fluid removal during dialysis is associated with cardiovascular
morbidity and mortality from HEMO study. Kidney Int. 2011
Pada kasus ini UFR berkisar
13 ml/kg/h dengan durasi
4-5 jam
37. UF profiling
53 pts, 188 HD session
In pts prone to IDH UF profile 1
(step wise decreasing) can reduce
the incidence of hypotension
Donauer J. Ultrafiltration Profiling and Measurement of Relative
Blood Volume to Reduce Hemodialysis-Related Side Effects. AJKD.
2000
38. Magdalene MA, Jennifer EF. Intradialytic Blood Pressure Abnormalities : The Highs, The Lows, and All That Lies Between. Am J Nephrol 2015;42:337-350
39. Approach to prevent and treat IDH
• Ertuglu LA et al. a review of intradialytic hypotension: concept, risk, clinical implication. Clin Kid Journal. 2020
40. • Restore the circulating blood volume by Trendelenburg position
• Reducing or stopping ultrafiltration
• Boluses of 0.9% isotonic saline (100 ml or more, as necessary).
• Blood flow rate should not be routinely reduced, attention to underdialysis
• Evaluation for life-threatening condition.
41. • Perlunya re-asses dry weight pada pasien ini.
• Menghindari makan besar selama sesi HD
• Menurunkan suhu dialisat (35-35.5 °C atau 0.5 °C dari suhu pasien)
• Tetap mengkonsumsi obat anti hipertensi dengan mengevaluasi efek
yang mungkin muncul selama sesi HD
43. Approach to prevent and treat IDH
• Ertuglu LA et al. a review of intradialytic hypotension: concept, risk, clinical implication. Clin Kid Journal. 2020
44.
45.
46.
47. Clinical Impact
• Intermittent drops in BP often without immediately visible harm.
• Is it harmful?
• Or just “one of those things” that happen?
48. Subclinical negative Impact
• Cardiac stunning: Echo during dialysis confirms the presence of LV
regional wall motion abnormality (Chesterton, Hemodialysis Int 2010)
• Episodic IDH exacerbate evolving myocardial injury
• Gut Stunning: Non occlusive mesenteric ischemia is associated with
frequent IDH (Daugirdas, AJKD, 2001)
• Mesenteric ischemia allow bacterial endotoxins to enter the circulation,
causing vasodilatation and reduced cardiac contractility (McIntyre, Seminars
in Dialysis, 2010)
49. Apparent Negative Impact
• AVF thrombosis rate is higher with IDH
• In patients with IDH>30% of all had 2x risk of AVF thrombosis
• Substandard dialysis treatment
• Negative perception of Dialysis
50. epidemiology
• 75% of all patients have had at least 1 episode in a study (……..)
• Occurs in 5-30% of all dialysis treatment
• In some patients, 50% of treatments are affected
• Older patients
• Longer dialysis vintage
• Diabetes
• Low pre dialysis blood pressure
• Higher UF goal
51. Fluid removal and hypotension
safe Ultrafiltration rate
• HEMO study: data from 1846 pts
• Compared by UF rates:
• Up to 10 ml/h/kg
• 70 kg pts, 3.5 hrs < 2.45 liter target
• 10-13 ml/h/kg
• 70 kg pts, 3.5 hrs 2.45-3.18 liter target
• Higher risk of CHF without mortality risk increased seen from this point
• Over 13 ml/h/kg
• 70 kg pts, 3.5 hrs. > 3.18 ltr
• Increased risk of mortality. All cause mortality 1.59 and CV mortality 1.7
• Jennifer Flythe et al. rapid removal during dialysis associated with Cardiovascular morbidity. Kidney Int. 2011
52. Dialysate temperature
• A reduction in dialysate temperature from 36.7-34.4 decreased the
frequency of IDH from 0.58-0.05 episodes per treatment in a study of
7 pts with frequent IDH (Sherman, 1985)
• Temperature setting of at least 1 degree from the actual body
temperature can prevent IDH.
• Multiple similar study results in the efficacy of lower dialysate
temperature.
53. Prevention of recurrent episodes
• Reassessing Dry weight
• Bioimpedance
• Trial and error
• Avoiding food: peripheral vascular resistance drops, up to 2 hours
following the ingestion
• BP medication adjustment
55. UF Rate death
Assimon MM, Wenger BJ et al. Am J Kid Disease.
2016
• US cohort (n 118.394
56. • Jelicic I. Relationship of a food intake during hemodialysis and symptomatic intradialytic hypotension. Hemodia Int. 2021
Fasting during hemodialysis
may cause significantly
lower frequency of
intradialytic hypotension
and cramping without
affecting the nutritional
status
