Prevention of Intradialytic Hypotension in Hemodialysis Patients: Current Challenges and Future Prospects

References

• Kalantar-Zadeh K, Jafar TH, Nitsch D, Neuen BL, Perkovic V. Chronic kidney disease. Lancet. 2021;398(10302):786–802. doi:10.1016/S0140-6736(21)00519-5
   PubMed Web of Science ®Google Scholar
• Thurlow JS, Joshi M, Yan G, et al. Global epidemiology of end-stage kidney disease and disparities in kidney replacement therapy. Am J Nephrol. 2021;52(2):98–107. doi:10.1159/000514550
   PubMed Web of Science ®Google Scholar
• Saran R, Robinson B, Abbott KC, et al. US renal data system 2016 annual data report: epidemiology of kidney disease in the United States. Am J Kidney Dis. 2017;69(3 Suppl 1):A7–A8. doi:10.1053/j.ajkd.2016.12.004
   PubMed Web of Science ®Google Scholar
• Hamrahian SM, Falkner B. Hypertension in chronic kidney disease. Hypertension: from basic research to clinical practice. Adv Exp Med Biol. 2017;956:307–325. doi:10.1007/5584_2016_84
   PubMed Web of Science ®Google Scholar
• Muntner P, Anderson A, Charleston J, et al. Hypertension awareness, treatment, and control in adults with CKD: results from the Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis. 2010;55(3):441–451. doi:10.1053/j.ajkd.2009.09.014
   PubMed Web of Science ®Google Scholar
• Liang Y, Gan L, Shen Y, et al. Clinical characteristics and management of hemodialysis patients with pre-dialysis hypertension: a multicenter observational study. Ren Fail. 2022;44(1):1811–1818. doi:10.1080/0886022X.2022.2136527
   PubMed Web of Science ®Google Scholar
• Fulop T, Schmidt DW, Cosmin A, et al. Ambulatory blood pressure monitoring and peri-hemodialysis blood pressures in a southeast US hemodialysis unit. Clin Nephrol. 2012;77(5):383–391. doi:10.5414/CN107138
   PubMed Web of Science ®Google Scholar
• Flythe JE, Xue H, Lynch KE, Curhan GC, Brunelli SM. Association of mortality risk with various definitions of intradialytic hypotension. J Am Soc Nephrol. 2015;26(3):724–734. doi:10.1681/ASN.2014020222
   PubMed Web of Science ®Google Scholar
• Bradshaw W, Bennett PN. Asymptomatic intradialytic hypotension: the need for pre-emptive intervention. Nephrol Nurs J. 2015;42(5):479–85; quiz 86.
   PubMed Web of Science ®Google Scholar
• Chou JA, Kalantar-Zadeh K, Mathew AT. A brief review of intradialytic hypotension with a focus on survival. Semin Dial. 2017;30(6):473–480. doi:10.1111/sdi.12627
   PubMed Web of Science ®Google Scholar
• Kuipers J, Verboom LM, Ipema KJR, et al. The prevalence of intradialytic hypotension in patients on conventional hemodialysis: a systematic review with meta-analysis. Am J Nephrol. 2019;49(6):497–506. doi:10.1159/000500877
   PubMed Web of Science ®Google Scholar
• Workgroup KD. K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis. 2005;45:S1–S153.
   Web of Science ®Google Scholar
• Ashby D, Borman N, Burton J, et al. Renal Association clinical practice guideline on haemodialysis. BMC Nephrol. 2019;20(1):379. doi:10.1186/s12882-019-1527-3
   PubMed Web of Science ®Google Scholar
• Kooman J, Basci A, Pizzarelli F, et al. EBPG guideline on haemodynamic instability. Nephrol Dial Transplant. 2007;2(suppl_2):ii22–ii44.
   Google Scholar
• Hirakata H, Nitta K, Inaba M, et al. Japanese society for dialysis therapy guidelines for management of cardiovascular diseases in patients on chronic hemodialysis. Ther Apher Dial. 2012;16(5):387–435. doi:10.1111/j.1744-9987.2012.01088.x
   PubMedGoogle Scholar
• Fuertinger DH, Kappel F, Meyring-Wösten A, Thijssen S, Kotanko P. A physiologically based model of vascular refilling during ultrafiltration in hemodialysis. J Theor Biol. 2016;390:146–155. doi:10.1016/j.jtbi.2015.11.012
   PubMed Web of Science ®Google Scholar
• Rubinger D, Backenroth R, Sapoznikov D. Sympathetic nervous system function and dysfunction in chronic hemodialysis patients. Semin Dial. 2013;26(3):333–343. doi:10.1111/sdi.12093
   PubMed Web of Science ®Google Scholar
• Daugirdas JT. Intradialytic hypotension and splanchnic shifting: integrating an overlooked mechanism with the detection of ischemia-related signals during hemodialysis. Semin Dial. 2019;32(3):243–247. doi:10.1111/sdi.12781
   PubMed Web of Science ®Google Scholar
• Escoli R, Carvalho MJ, Cabrita A, Rodrigues A. Diastolic dysfunction, an underestimated new challenge in dialysis. Ther Apher Dial. 2019;23(2):108–117. doi:10.1111/1744-9987.12756
   PubMed Web of Science ®Google Scholar
• Yu J, Chen X, Li Y, et al. Pro-inflammatory cytokines as potential predictors for intradialytic hypotension. Ren Fail. 2021;43(1):198–205. doi:10.1080/0886022X.2021.1871921
   PubMed Web of Science ®Google Scholar
• Burton JO, Jefferies HJ, Selby NM, McIntyre CW. Hemodialysis-induced cardiac injury: determinants and associated outcomes. Clin J Am Soc Nephrol. 2009;4(5):914–920. doi:10.2215/CJN.03900808
   PubMed Web of Science ®Google Scholar
• Yu J, Chen X, Li Y, et al. High ultrafiltration rate induced intradialytic hypotension is a predictor for cardiac remodeling: a 5-year cohort study. Ren Fail. 2021;43(1):40–48. doi:10.1080/0886022X.2020.1853570
   PubMed Web of Science ®Google Scholar
• Zoccali C, Moissl U, Chazot C, et al. Chronic fluid overload and mortality in ESRD. J Am Soc Nephrol. 2017;28(8):2491–2497. doi:10.1681/ASN.2016121341
   PubMed Web of Science ®Google Scholar
• Levin NW, de Abreu M, Borges LE, et al. Hemodynamic response to fluid removal during hemodialysis: categorization of causes of intradialytic hypotension. Nephrol Dial Transplant. 2018;33(9):1643–1649. doi:10.1093/ndt/gfy048
   PubMed Web of Science ®Google Scholar
• Singh AT, Mc Causland FR. Osmolality and blood pressure stability during hemodialysis. Semin Dial. 2017;30(6):509–517. doi:10.1111/sdi.12629
   PubMed Web of Science ®Google Scholar
• Flythe JE, Kimmel SE, Brunelli SM. Rapid fluid removal during dialysis is associated with cardiovascular morbidity and mortality. Kidney Int. 2011;79(2):250–257. doi:10.1038/ki.2010.383
   PubMed Web of Science ®Google Scholar
• Calvo C, Maule S, Mecca F, Quadri R, Martina G, Cavallo Perin P. The influence of autonomic neuropathy on hypotension during hemodialysis. Clin Auton Res. 2002;12(2):84–87. doi:10.1007/s102860200025
   PubMed Web of Science ®Google Scholar
• Donauer J, Kölblin D, Bek M, Krause A, Böhler J. Ultrafiltration profiling and measurement of relative blood volume as strategies to reduce hemodialysis-related side effects. Am J Kidney Dis. 2000;36(1):115–123. doi:10.1053/ajkd.2000.8280
   PubMed Web of Science ®Google Scholar
• Mc Causland FR, Brunelli SM, Waikar SS. Dialysis dose and intradialytic hypotension: results from the HEMO study. Am J Nephrol. 2013;38(5):388–396. doi:10.1159/000355958
   PubMed Web of Science ®Google Scholar
• Mc Causland FR, Waikar SS. Association of predialysis calculated plasma osmolarity with intradialytic blood pressure decline. Am J Kidney Dis. 2015;66(3):499–506. doi:10.1053/j.ajkd.2015.03.028
   PubMed Web of Science ®Google Scholar
• Tangvoraphonkchai K, Davenport A. Why does the choice of dialysate sodium concentration remain controversial? Hemodial Int. 2018;22(4):435–444. doi:10.1111/hdi.12645
   PubMed Web of Science ®Google Scholar
• Murugan R, Bellomo R, Palevsky PM, Kellum JA. Ultrafiltration in critically ill patients treated with kidney replacement therapy. Nat Rev Nephrol. 2021;17(4):262–276. doi:10.1038/s41581-020-00358-3
   PubMed Web of Science ®Google Scholar
• Gabutti L, Ferrari N, Giudici G, Mombelli G, Marone C. Unexpected haemodynamic instability associated with standard bicarbonate haemodialysis. Nephrol Dial Transplant. 2003;18(11):2369–2376. doi:10.1093/ndt/gfg383
   PubMed Web of Science ®Google Scholar
• Gabutti L, Bianchi G, Soldini D, Marone C, Burnier M. Haemodynamic consequences of changing bicarbonate and calcium concentrations in haemodialysis fluids. Nephrol Dial Transplant. 2009;24(3):973–981. doi:10.1093/ndt/gfn541
   PubMed Web of Science ®Google Scholar
• Takahashi A. The pathophysiology of leg cramping during dialysis and the use of carnitine in its treatment. Physiol Rep. 2021;9(21):e15114. doi:10.14814/phy2.15114
   PubMed Web of Science ®Google Scholar
• Soliman KM, Salim SA, Fülöp T. Hypocalcemia and cramping in dialysis patients. J Parathyr Dis. 2019;7:16–18.
   Google Scholar
• Wieliczko M, Malyszko J. Acid-base balance in hemodialysis patients in everyday practice. Ren Fail. 2022;44(1):1090–1097. doi:10.1080/0886022X.2022.2094805
   PubMed Web of Science ®Google Scholar
• Kourtellidou SI, Ashby DR, Johansson LR. Oral sodium bicarbonate in people on haemodialysis: a randomised controlled trial. BMC Nephrol. 2021;22(1):346. doi:10.1186/s12882-021-02549-x
   PubMed Web of Science ®Google Scholar
• Hamrahian SM. Hypertension and cardiovascular disease in patients with chronic kidney disease. In: Approaches to Chronic Kidney Disease: A Guide for Primary Care Providers and Non-Nephrologists. Springer; 2022:281–295.
   Google Scholar
• Modi ZJ, Lu Y, Ji N, et al. Risk of cardiovascular disease and mortality in young adults with end-stage renal disease: an analysis of the US renal data system. JAMA Cardiol. 2019;4(4):353–362. doi:10.1001/jamacardio.2019.0375
   PubMed Web of Science ®Google Scholar
• Owen PJ, Priestman WS, Sigrist MK, et al. Myocardial contractile function and intradialytic hypotension. Hemodial Int. 2009;13(3):293–300. doi:10.1111/j.1542-4758.2009.00365.x
   PubMed Web of Science ®Google Scholar
• Dorairajan S, Chockalingam A, Misra M. Myocardial stunning in hemodialysis: what is the overall message? Hemodial Int. 2010;14(4):447–450. doi:10.1111/j.1542-4758.2010.00495.x
   PubMed Web of Science ®Google Scholar
• Nette RW, van den Dorpel MA, Krepel HP, et al. Hypotension during hemodialysis results from an impairment of arteriolar tone and left ventricular function. Clin Nephrol. 2005;63(4):276–283. doi:10.5414/CNP63276
   PubMed Web of Science ®Google Scholar
• Shafi T, Mullangi S, Jaar BG, Silber H. Autonomic dysfunction as a mechanism of intradialytic blood pressure instability. Semin Dial. 2017;30(6):537–544. doi:10.1111/sdi.12635
   PubMed Web of Science ®Google Scholar
• Adragao T, Herberth J, Monier-Faugere MC, et al. Low bone volume--a risk factor for coronary calcifications in hemodialysis patients. Clin J Am Soc Nephrol. 2009;4(2):450–455. doi:10.2215/CJN.01870408
   PubMed Web of Science ®Google Scholar
• Dubin R, Owens C, Gasper W, Ganz P, Johansen K. Associations of endothelial dysfunction and arterial stiffness with intradialytic hypotension and hypertension. Hemodial Int. 2011;15(3):350–358. doi:10.1111/j.1542-4758.2011.00560.x
   PubMed Web of Science ®Google Scholar
• Kim SY, Hong YA, Yoon HE, et al. Vascular calcification and intradialytic hypotension in hemodialysis patients: clinical relevance and impact on morbidity and mortality. Int J Cardiol. 2016;217:156–160. doi:10.1016/j.ijcard.2016.04.183
   PubMed Web of Science ®Google Scholar
• Shibagaki Y, Takaichi K. Significant reduction of the large-vessel blood volume by food intake during hemodialysis. Clin Nephrol. 1998;49(1):49–54.
   PubMed Web of Science ®Google Scholar
• Avci M, Arikan F. The effect of food intake during hemodialysis on blood pressure: a nonrandomized experimental trial. Ther Apher Dial. 2023;27(4):661–668. doi:10.1111/1744-9987.13967
   PubMed Web of Science ®Google Scholar
• Zoccali C, Mallamaci F, Ciccarelli M, Maggiore Q. Postprandial alterations in arterial pressure control during hemodialysis in uremic patients. Clin Nephrol. 1989;31(6):323–326.
   PubMed Web of Science ®Google Scholar
• Choi MS, Kistler B, Wiese GN, et al. Pilot Study of the effects of high-protein meals during hemodialysis on intradialytic hypotension in patients undergoing maintenance hemodialysis. J Ren Nutr. 2019;29(2):102–111. doi:10.1053/j.jrn.2018.06.002
   PubMed Web of Science ®Google Scholar
• Pizzarelli F. From cold dialysis to isothermic dialysis: a twenty-five year voyage. Nephrol Dial Transplant. 2007;22(4):1007–1012. doi:10.1093/ndt/gfl822
   PubMed Web of Science ®Google Scholar
• Mustafa RA, Bdair F, Akl EA, et al. Effect of lowering the dialysate temperature in chronic hemodialysis: a systematic review and meta-analysis. Clin J Am Soc Nephrol. 2016;11(3):442–457. doi:10.2215/CJN.04580415
   PubMed Web of Science ®Google Scholar
• Lim Y, Yang G, Cho S, Kim SR, Lee Y-J. Association between ultrafiltration rate and clinical outcome is modified by muscle mass in hemodialysis patients. Nephron. 2020;144(9):447–452. doi:10.1159/000509350
   PubMed Web of Science ®Google Scholar
• Son HE, Ryu JY, Lee K, et al. The importance of muscle mass in predicting intradialytic hypotension in patients undergoing maintenance hemodialysis. Kidney Res Clin Pract. 2022;41(5):611–622. doi:10.23876/j.krcp.21.153
   PubMed Web of Science ®Google Scholar
• Tian M, Zha Y, Qie S, Lin X, Yuan J. Association of body composition and intradialytic hypotension in hemodialysis patients. Blood Purif. 2020;49(3):334–340. doi:10.1159/000504245
   PubMed Web of Science ®Google Scholar
• Sarafidis PA, Persu A, Agarwal R, et al. Hypertension in dialysis patients: a consensus document by the European Renal and Cardiovascular Medicine (EURECA-m) working group of the European Renal Association–European Dialysis and Transplant Association (ERA-EDTA) and the hypertension and the kidney working group of the European Society of Hypertension (ESH). Nephrol Dial Transplant. 2017;32(4):620–640.
   PubMed Web of Science ®Google Scholar
• Wang KM, Sirich TL, Chang TI. Timing of blood pressure medications and intradialytic hypotension. Semin Dial. 2019;32(3):201–204. doi:10.1111/sdi.12777
   PubMed Web of Science ®Google Scholar
• Assimon MM, Brookhart MA, Fine JP, Heiss G, Layton JB, Flythe JE. A comparative study of carvedilol versus metoprolol initiation and 1-year mortality among individuals receiving maintenance hemodialysis. Am J Kidney Dis. 2018;72(3):337–348. doi:10.1053/j.ajkd.2018.02.350
   PubMed Web of Science ®Google Scholar
• Denker MG, Cohen DL. Antihypertensive medications in end-stage renal disease. Semin Dial. 2015;28(4):330–336. doi:10.1111/sdi.12369
   PubMed Web of Science ®Google Scholar
• Mensack S. Metabolic Acidosis. Critical Care. Routledge; 2021:30–31.
   Google Scholar
• Mora-Bravo FG, De-La-Cruz G, Rivera S, Ramirez AM, Raimann JG, Perez-Grovas H. Association of intradialytic hypotension and convective volume in hemodiafiltration: results from a retrospective cohort study. BMC Nephrol. 2012;13(1):106. doi:10.1186/1471-2369-13-106
   PubMedGoogle Scholar
• Vilar E, Fry AC, Wellsted D, Tattersall JE, Greenwood RN, Farrington K. Long-term outcomes in online hemodiafiltration and high-flux hemodialysis: a comparative analysis. Clin J Am Soc Nephrol. 2009;4(12):1944–1953. doi:10.2215/CJN.05560809
   PubMed Web of Science ®Google Scholar
• Pinney JH, Oates T, Davenport A. Haemodiafiltration does not reduce the frequency of intradialytic hypotensive episodes when compared to cooled high-flux haemodialysis. Nephron Clin Pract. 2011;119(2):c138–c144. doi:10.1159/000324428
   PubMedGoogle Scholar
• Tanemoto M, Ishimoto Y, Kosako Y, Okazaki Y. Comparison of intradialytic plasma volume change between online hemodiafiltration and standard hemodialysis. Ren Replace Ther. 2018;4(1):1–6. doi:10.1186/s41100-018-0188-1
   Google Scholar
• Fülöp T, Tapolyai MB, Zsom L, et al. Successful practice transitioning between hemodialysis and hemodiafiltration in outpatient units: ten key issues for physicians to remember. Artif Organs. 2018;42(9):925–932. doi:10.1111/aor.13135
   PubMed Web of Science ®Google Scholar
• Canaud B, Chazot C, Koomans J, Collins A. Fluid and hemodynamic management in hemodialysis patients: challenges and opportunities. J Bras Nefrol. 2019;41(4):550–559. doi:10.1590/2175-8239-jbn-2019-0135
   PubMedGoogle Scholar
• Tapolyai MB, Faludi M, Fülöp T, Dossabhoy NR, Szombathelyi A, Berta K. Which fluid space is affected by ultrafiltration during hemodiafiltration? Hemodial Int. 2014;18(2):384–390. doi:10.1111/hdi.12125
   PubMed Web of Science ®Google Scholar
• Tapolyai M, Faludi M, Reti V, Lengvarszky Z, Szarvas T, Berta K. Dialysis patients’ fluid overload, antihypertensive medications, and obesity. ASAIO J. 2011;57(6):511–515. doi:10.1097/MAT.0b013e3182377216
   PubMed Web of Science ®Google Scholar
• Tapolyai M, Faludi M, Reti V, et al. Volume estimation in dialysis patients: the concordance of brain-type natriuretic peptide measurements and bioimpedance values. Hemodial Int. 2013;17(3):406–412. doi:10.1111/hdi.12023
   PubMed Web of Science ®Google Scholar
• Allinovi M, Palazzini G, Lugli G, et al. Pre-dialysis B-line quantification at lung ultrasound is a useful method for evaluating the dry weight and predicting the risk of intradialytic hypotension. Diagnostics. 2022;12(12):2990. doi:10.3390/diagnostics12122990
   Web of Science ®Google Scholar
• Kaptein EM, Cantillep A, Kaptein JS, et al. Comparison of respiratory variations of subclavian vein and inferior vena cava in hospitalized patients with kidney disease. Int J Nephrol Renovasc Dis. 2020;13:329–339. doi:10.2147/IJNRD.S280458
   PubMed Web of Science ®Google Scholar
• Zschätzsch S, Stauss-Grabo M, Gauly A, Braun J. Integrating monitoring of volume status and blood volume-controlled ultrafiltration into extracorporeal kidney replacement therapy. Int J Nephrol Renovasc Dis. 2021;349–358. doi:10.2147/IJNRD.S319911
   PubMed Web of Science ®Google Scholar
• Brennan JM, Ronan A, Goonewardena S, et al. Handcarried ultrasound measurement of the inferior vena cava for assessment of intravascular volume status in the outpatient hemodialysis clinic. Clin J Am Soc Nephrol. 2006;1(4):749–753. doi:10.2215/CJN.00310106
   PubMed Web of Science ®Google Scholar
• Hsieh MY, Cheng CH, Chen CH, et al. The association of long-term blood pressure variability with hemodialysis access thrombosis. Front Cardiovasc Med. 2022;9:881454. doi:10.3389/fcvm.2022.881454
   PubMed Web of Science ®Google Scholar
• Caplin B, Kumar S, Davenport A. Patients’ perspective of haemodialysis-associated symptoms. Nephrol Dial Transplant. 2011;26(8):2656–2663. doi:10.1093/ndt/gfq763
   PubMed Web of Science ®Google Scholar
• Assimon MM, Wang L, Flythe JE. Cumulative exposure to frequent intradialytic hypotension associates with new-onset dementia among elderly hemodialysis patients. Kidney Int Rep. 2019;4(4):603. doi:10.1016/j.ekir.2019.01.001
   PubMed Web of Science ®Google Scholar
• Zsom L, Zsom M, Abdul Salim S, Fulop T. Subjective global assessment of nutrition, dialysis quality, and the theory of the scientific method in nephrology practice. Artif Organs. 2020;44(10):1021–1030. doi:10.1111/aor.13762
   PubMed Web of Science ®Google Scholar
• Guedes M, Pecoits-Filho R, Leme JEG, et al. Impacts of dialysis adequacy and intradialytic hypotension on changes in dialysis recovery time. BMC Nephrol. 2020;21(1):529. doi:10.1186/s12882-020-02187-9
   PubMed Web of Science ®Google Scholar
• Kim YS, Davis SC, Truijen J, Stok WJ, Secher NH, van Lieshout JJ. Intensive blood pressure control affects cerebral blood flow in type 2 diabetes mellitus patients. Hypertension. 2011;57(4):738–745. doi:10.1161/HYPERTENSIONAHA.110.160523
   PubMed Web of Science ®Google Scholar
• Assimon MM, Wenger JB, Wang L, Flythe JE. Ultrafiltration rate and mortality in maintenance hemodialysis patients. Am J Kidney Dis. 2016;68(6):911–922. doi:10.1053/j.ajkd.2016.06.020
   PubMed Web of Science ®Google Scholar
• Shemin D, Bostom AG, Laliberty P, Dworkin LD. Residual renal function and mortality risk in hemodialysis patients. Am J Kidney Dis. 2001;38(1):85–90. doi:10.1053/ajkd.2001.25198
   PubMed Web of Science ®Google Scholar
• Chang TI, Paik J, Greene T, et al. Intradialytic hypotension and vascular access thrombosis. J Am Soc Nephrol. 2011;22(8):1526–1533. doi:10.1681/ASN.2010101119
   PubMed Web of Science ®Google Scholar
• Furukawa K, Ikeda S, Naito T, et al. Cardiac function in dialysis patients evaluated by Doppler echocardiography and its relation to intradialytic hypotension: a new index combining systolic and diastolic function. Clin Nephrol. 2000;53(1):18–24.
   PubMed Web of Science ®Google Scholar
• Sinha AD, Agarwal R. Setting the dry weight and its cardiovascular implications. Semin Dial. 2017;30(6):481–488. doi:10.1111/sdi.12624
   PubMed Web of Science ®Google Scholar
• Tomson CR. Advising dialysis patients to restrict fluid intake without restricting sodium intake is not based on evidence and is a waste of time. Nephrol Dial Transplant. 2001;16(8):1538–1542. doi:10.1093/ndt/16.8.1538
   PubMed Web of Science ®Google Scholar
• Bossola M, Pepe G, Vulpio C. The frustrating attempt to limit the interdialytic weight gain in patients on chronic hemodialysis: new insights into an old problem. J Ren Nutr. 2018;28(5):293–301. doi:10.1053/j.jrn.2018.01.015
   PubMed Web of Science ®Google Scholar
• Jelicic I. Relationship of a food intake during hemodialysis and symptomatic intradialytic hypotension. Hemodial Int. 2021;25(3):333–337. doi:10.1111/hdi.12923
   Web of Science ®Google Scholar
• Hussein WF, Schiller B. Dialysate sodium and intradialytic hypotension. Semin Dial. 2017;30(6):492–500. doi:10.1111/sdi.12634
   PubMed Web of Science ®Google Scholar
• Aronoff GR. The effect of treatment time, dialysis frequency, and ultrafiltration rate on intradialytic hypotension. Semin Dial. 2017;30(6):489–491. doi:10.1111/sdi.12625
   PubMed Web of Science ®Google Scholar
• van der Sande FM, Cheriex EC, van Kuijk WH, Leunissen KM. Effect of dialysate calcium concentrations on intradialytic blood pressure course in cardiac-compromised patients. Am J Kidney Dis. 1998;32(1):125–131. doi:10.1053/ajkd.1998.v32.pm9669433
   PubMed Web of Science ®Google Scholar
• Tsujimoto Y, Tsujimoto H, Nakata Y, et al. Dialysate temperature reduction for intradialytic hypotension for people with chronic kidney disease requiring haemodialysis. Cochrane Database Syst Rev. 2019;7(7):CD012598. doi:10.1002/14651858.CD012598.pub2
   PubMedGoogle Scholar
• Chang TI. Impact of drugs on intradialytic hypotension: antihypertensives and vasoconstrictors. Semin Dial. 2017;30(6):532–536. doi:10.1111/sdi.12633
   PubMed Web of Science ®Google Scholar
• Brunelli SM, Cohen DE, Marlowe G, Van Wyck D. The impact of midodrine on outcomes in patients with intradialytic hypotension. Am J Nephrol. 2018;48(5):381–388. doi:10.1159/000494806
   PubMed Web of Science ®Google Scholar
• Wasserstein AG. L-carnitine supplementation in dialysis: treatment in quest of disease. Semin Dial. 2013;26(1):11–15. doi:10.1111/sdi.12041
   PubMed Web of Science ®Google Scholar
• Chewcharat A, Chewcharat P, Liu W, et al. The effect of levocarnitine supplementation on dialysis-related hypotension: a systematic review, meta-analysis, and trial sequential analysis. PLoS One. 2022;17(7):e0271307. doi:10.1371/journal.pone.0271307
   PubMed Web of Science ®Google Scholar
• Lee H, Moon SJ, Kim SW, et al. Prediction of intradialytic hypotension using pre-dialysis features - a deep learning-based artificial intelligence model. Nephrol Dial Transplant. 2023:gfad064. doi:10.1093/ndt/gfad064
   PubMed Web of Science ®Google Scholar
• Kim HW, Heo SJ, Kim M, et al. Deep learning model for predicting intradialytic hypotension without privacy infringement: a retrospective two-center study. Front Med. 2022;9:878858. doi:10.3389/fmed.2022.878858
   Web of Science ®Google Scholar
• Vaid A, Takkavatakarn K, Divers J, Charytan DM, Chan L, Nadkarni GN. Deep learning on electrocardiograms for prediction of in-hospital intradialytic hypotension in ESKD patients. Kidney360. 2023;10–34067. doi:10.34067/KID.0000092022
   PubMedGoogle Scholar