title: Intradialytic Blood Pressure Abnormalities: The Highs, The Lows and All That Lies Between.
abstract: BACKGROUND
  Frequent blood pressure (BP) measurements are necessary to ensure patient safety during hemodialysis treatments. Intradialytic BPs are not optimal tools for hypertension diagnosis and cardiovascular risk stratification, but they do have critical clinical and prognostic significance. We present evidence associating intradialytic BP phenomena including fall, rise and variability with adverse clinical outcomes and review related pathophysiologic mechanisms and potential management strategies.
  
  
  CONCLUSIONS
  Observational studies demonstrate associations between intradialytic hypotension, hypertension and BP variability and mortality. Lack of consensus regarding diagnostic criteria has hampered data synthesis, and prospective studies investigating optimal management strategies for BP phenomena are lacking. Mechanistic data suggest that cardiac, gut, kidney and brain ischemia may lie on the causal pathway between intradialytic hypotension and mortality, and endothelial cell dysfunction, among other factors, may be an important mediator of intradialytic hypertension and adverse outcomes. These plausible pathophysiologic links present potential therapeutic targets for future inquiry. The phenomenon of intradialytic BP variability has not been adequately studied, and practical clinical measures and treatment strategies are lacking.
  
  
  CONCLUSIONS
  Intradialytic BP phenomena have important prognostic bearing. Clinical practice guidelines for both intradialytic hypotension and hypertension exist, but their underlying evidence is weak overall. Further research is needed to develop consensus diagnostic criteria for intradialytic hypotension, hypertension and BP variability and to elucidate optimal treatment and prevention strategies for each BP manifestation.
authors.affiliation: University of North Carolina Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine, Chapel Hill, N.C., USA.
authors.forename: Magdalene M
authors.initials: MM
authors.lastname: Assimon
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Flythe
mesh_terms: D001794:Blood Pressure; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D007022:Hypotension / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D011446:Prospective Studies; D006435:Renal Dialysis