EBPG guideline on haemodynamic instability

Outline Introduction Definition of intra-dialytic hypotension (IDH) Incidence of IDH Relation between IDH and outcome Patients at risk for IDH Pathophysiology of IDH Prevention of IDH1. Evaluation of the patient 1.1 Assessment of dry weight 1.2 Measurement of blood pressure and heart rate during dialysis 1.3 Cardiac evaluation 2. Lifestyle interventions 2.1 Sodium restriction 2.2 Food and caffeine intake during dialysis 3. Factors relation to the dialysis treatment 3.1 Manipulation of ultrafiltration 3.1.1 Ultrafiltration profiling 3.1.2 Blood volume controlled ultrafiltration 3.2 Dialysate composition 3.2.1 High sodium dialysis and sodium profiling 3.2.2 Dialysate buffer 3.2.3 Dialysate calcium 3.2.4 Other components of dialysate 3.3 Dialysis membranes/contamination of dialysate 3.4 Dialysate temperature 3.5 Convective techniques and isolated ultrafiltration 3.5.1 Convective techniques 3.5.2 Isolated ultrafiltration 3.6 Dialysis duration and frequency 3.7 Switch to peritoneal dialysis 4. Antihypertensive drugs and preventive medication 4.1 Antihypertensive drugs 4.2 Preventive vasoactive agents 4.3 Carnitine 5. Stratified approach to prevent IDH6. Treatment of IDH 6.1 Trendelenburg position 6.2 Stopping ultrafiltration 6.3 Infusion fluids 6.4 Protocol