MANAGEMENT OF HEMODYNAMIC INSTABILITY IN CRITICALLY ILL PATIENTS UNDERGOING HEMODIALYSIS
DOI:
https://doi.org/10.61164/a53gey84Keywords:
Hemodialysis, Hemodynamic instability, Critical ill patientAbstract
Hemodialysis is commonly indicated in critically ill patients for various conditions, including acute kidney injury (AKI). During dialysis therapy, episodes of significant hemodynamic instability can occur, notably arterial hypotension. This integrative review aimed to identify and synthesize current strategies for managing hemodynamic instability induced by hemodialysis in critically ill patients. The search for articles between 2015 and 2025 was conducted in the PubMed/MEDLINE, CINAHL, Cochrane Library, LILACS, and BDENF databases. 105 studies were found. After applying inclusion and exclusion criteria, 5 articles were selected for full-text reading. The results showed that the most effective strategies for preventing and managing intradialytic hypotension are intravenous albumin infusion and the use of cold dialysate. Sodium modulation can also be effective when combined with an ascending-descending UF profile. More multicenter studies with larger samples are needed to better guide clinical practice.
Downloads
References
Arasnezhad, Morteza et al. The effect of ascending- descending ultrafiltration and sodium profiles on blood pressure in hemodialysis patients: a randomized cross-over study. BMC Nephrology, v. 25, n. 1, p. 128, 11 abr. 2024.
Belinskaia, Daria A.; Jenkins, Richard O.; Goncharov, Nikolay V. Serum Albumin in Health and Disease: From Comparative Biochemistry to Translational Medicine. International Journal of Molecular Sciences, v. 24, n. 18, p. 13725, 6 set. 2023.
Bellomo, R., Baldwin, I., Ronco, C., & Kellum, J. A. (2021). ICU-Based Renal Replacement Therapy. Critical Care Medicine, 49(3), 406-418. https://doi.org/10.1097/CCM.0000000000004831
Berger, David; Takala, Jukka. Hypotension and hypovolemia during hemodialysis: is the usual suspect innocent? Critical Care, v. 20, n. 1, p. 140, 9 jun. 2016.
Bitker, Laurent et al. Prevalence and risk factors of hypotension associated with preload-dependence during intermittent hemodialysis in critically ill patients. Critical Care, v. 20, n. 1, p. 44, 23 fev. 2016.
Braz, José Reinaldo Cerqueira; Castiglia, Yara Marcondes Machado. Temas de anestesiologia - 2a edição: Para o curso de graduação em medicina. [S.l.]: Editora Unesp, 2022.
Clark, Edward G. et al. Intravenous albumin for the prevention of hemodynamic instability during sustained low-efficiency dialysis: a randomized controlled feasibility trial (The SAFER-SLED Study). Annals of Intensive Care, v. 11, n. 1, p. 174, 13 dez. 2021.
Dalbhi, Sultan Al et al. Sustained low efficiency dialysis is non-inferior to continuous renal replacement therapy in critically ill patients with acute kidney injury. Medicine, v. 100, n. 51, p. e28118, 23 dez. 2021.
Habas, Elmukhtar et al. Common complications of hemodialysis: A clinical review. Ibnosina Journal of Medicine and Biomedical Sciences, v. 13, p. 161–172, 14 jul. 2022.
HALL, John E.; HALL, Michael E. Guyton & Hall: Tratado de Fisiologia Médica. 14. ed. Rio de Janeiro: Guanabara Koogan, 2021.
Macedo, Etienne et al. A randomized trial of albumin infusion to prevent intradialytic hypotension in hospitalized hypoalbuminemic patients. Critical Care (London, England), v. 25, n. 1, p. 18, 6 jan. 2021.
Mcintyre, Christopher W. Update on Hemodialysis-Induced Multiorgan Ischemia: Brains and Beyond. Journal of the American Society of Nephrology: JASN, v. 35, n. 5, p. 653–664, 1 maio 2024.
Medeiros, Denise Delmonde et al. Avaliação do uso de albumina humana em pacientes pediátricos em hospital terciário do Piauí. OBSERVATÓRIO DE LA ECONOMÍA LATINOAMERICANA, v. 23, n. 10, p. e11864–e11864, 16 out. 2025.
Neyra, Javier A. et al. Association of vasopressor use during renal replacement therapy and mortality. Journal of Critical Care, v. 89, p. 155103, 1 out. 2025.
Sáez, Alain León et al. Influência da albumina e do ângulo de fase na sobrevida de pacientes com doença renal crônica em hemodiálise: um estudo prospectivo. Brazilian Journal of Nephrology, v. 47, p. e20240207, 2025.
Sakkas, Giorgos K. et al. Cold dialysis and its impact on renal patients’ health: An evidence-based mini review. World Journal of Nephrology, v. 6, n. 3, p. 119–122, 6 maio 2017.
Santos, Reginaldo Passoni dos et al. Complicações intradialíticas em pacientes com injúria renal aguda. Acta Paulista de Enfermagem, v. 35, p. eAPE0168345, 2022.
Tankudar, Srijan; Palvevsky, Paul M. Continuous Renal Replacement Therapy. Chest, v. 155, n. 3, p. 626–638, mar. 2019.
Toth-Manikowski, Stephanie M.; SOZIO, Stephen M. Cooling dialysate during in-center hemodialysis: Beneficial and deleterious effects. World Journal of Nephrology, v. 5, n. 2, p. 166–171, 6 mar. 2016.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Guilherme Campelo da Cruz, Ana Claudia Rodrigues da Silva
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish in this journal agree to the following terms:
Authors retain copyright and grant the journal the right of first publication, with the work simultaneously licensed under the Creative Commons Attribution License, which permits the sharing of the work with proper acknowledgment of authorship and initial publication in this journal;
Authors are authorized to enter into separate, additional agreements for the non-exclusive distribution of the version of the work published in this journal (e.g., posting in an institutional repository or publishing it as a book chapter), provided that authorship and initial publication in this journal are properly acknowledged, and that the work is adapted to the template of the respective repository;
Authors are permitted and encouraged to post and distribute their work online (e.g., in institutional repositories or on their personal websites) at any point before or during the editorial process, as this may lead to productive exchanges and increase the impact and citation of the published work (see The Effect of Open Access);
Authors are responsible for correctly providing their personal information, including name, keywords, abstracts, and other relevant data, thereby defining how they wish to be cited. The journal’s editorial board is not responsible for any errors or inconsistencies in these records.
PRIVACY POLICY
The names and email addresses provided to this journal will be used exclusively for the purposes of this publication and will not be made available for any other purpose or to third parties.
Note: All content of the work is the sole responsibility of the author and the advisor.
