الفهرس 
Definition of chronic kidney disease
Estimation Equations:Only 14 pages are availabe for public view
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Abstract
IDH is the most common complication during heamodialysis,
Repeated episodes of IDH have been established as a significant
and independent risk factor for increased morbidityand mortality in
hemodialysis patients. This makes treatment and prevention of IDH
an important part of both short- and long-term HD strategy.
IDH may also carry the risk of reduced perfusion to other
vascular beds in vulnerable organ systems, such as brain and
therefore contribute to the higher risk of cerebrovascular events in
dialysis patient.
IDH is the clinical manifestation of an imbalance between the
decreases in plasma volume during dialysis and the counter
regulatory cardiovascular hemodynamic and neurohumoral
mechanisms.
Some features of IDH are directly related to the dialysis
procedure itself such as ultrafiltration rate, increased temperature,
and acetate dialysate. Several patient characteristics increase the
risk of IDH, such as older age, diabetes, left ventricular hypertrophy,
coronary artery disease, autonomic neuropathy, excessive
intradialytic weight gain and low ejection fraction.
IDH can induce cardiac arrhythmias and predispose to
myocardial ischemia, and myocardiac stunning, which in turn
increases the risk for sudden cardiac death, being a common cause
of death in dialysis patients. The prevention of IDH has been the subject of intense
research in recent years and has resulted in a range of techniques
which aim at solving this issue. These techniques include improved
assessment of the patient’s “dry weight”, cooler dialysate
temperature, dialysate sodium concentration and Na profiling.
The treatment includes stopping or slowing the rate of
ultrafiltration, placing the patient in the trendelenburg position,
decreasing the blood flow rate, and restoring intravascular volume.
Also,pharmacologic interventions should be considered. A number
of medications are available such as caffeine, sertraline, midodrine,
vasopressin, etc.