Table 2.

Treatment of hemodynamic instabilitya

Exclude non–dialysis-related cause (cardiac ischemia, pericardial effusion, infection)
Individualize the dialysis prescription
    accurate setting of the dry weight
    optimize dialysate composition
        fixed Na+ concentration >140 mEq/L         or Na+ modeling
        HCO3 buffer
        avoid low Mg2+ dialysate
        avoid low Ca2+ dialysate
    optimize method of UF
        UF modeling alone or with Na+         modeling
        sequential UF and isovolemic dialysis
    cool temperature dialysate
Maximize cardiac performance
    inflatable abdominal band to enhance venous return to heart
Avoidance of food
Avoid antihypertensive medicines on dialysis day
Pharmacologic interventions
    midodrine
    vasopressin
    adenosine antagonists
    others: sertraline, ephedrine, phenylephrine, carnitine
  • a UF, ultrafiltration.