Attending RoundsAttending Rounds A Patient with Intradialytic HypotensionReilly, Robert F. Author Information Division of Nephrology, Medical Service, Veterans Affairs North Texas Health Care System, Dallas, Texas; and Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas Correspondence: Dr. Robert F. Reilly, 4500 South Lancaster Road, Medical Service, Nephrology Section (111G1), Dallas, TX 75216. Email: [email protected] Clinical Journal of the American Society of Nephrology 9(4):p 798-803, April 2014. | DOI: 10.2215/CJN.09930913 Buy Metrics Abstract Intradialytic hypotension is the most common adverse event that occurs during the hemodialysis procedure. Despite advances in machine technology, it remains a difficult management issue. The pathophysiology of intradialytic hypotension and measures to reduce its frequency are discussed. An accurate assessment of dry weight is crucial in all patients on dialysis and especially those patients prone to intradialytic hypotension. The presence of edema and hypertension has recently been shown to be a poor predictor of volume overload. Noninvasive methods to assess volume status, such as whole body and segmental bioimpedance, hold promise to more accurately assess fluid status. Reducing salt intake is key to limiting interdialytic weight gain. A common problem is that patients are often told to restrict fluid but not salt intake. Lowering the dialysate temperature, prohibiting food ingestion during hemodialysis, and midodrine administration are beneficial. Sodium modeling in the absence of ultrafiltration modeling should be abandoned. There is not enough data on the efficacy of L-carnitine to warrant its routine use. Copyright © 2014 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.