Hemodialysis.-Induced Hypotension Therapy for End Stage Kidney Disease

Inclusion criteria

• Subjects age 18 to 85 years
• On thrice-weekly hemodialysis for at least six months
• Clinically stable, adequately dialyzed (single-pool Kt/V > 1.2), with polysulphone membrane for at least three consecutive months before the study
• Subjects with pre-dialytic systolic blood pressure between 110 and 170 mmHg.
• Subjects with a reduction of systolic blood pressure during hemodialysis equal to or greater than 30 mmHg, with associated symptoms such as nausea, vomiting, muscle cramps, dizziness, or anxiety.
• Hypotensive episodes should occur four times or more in four weeks (12 hemodialysis sessions).

Exclusion criteria

• Subjects with intradialytic hypotension that require the use of pharmacological intervention such as midodrine or vasopressin
• Subjects with pre-dialytic systolic blood pressure greater than 170 mmHg or diastolic blood pressure greater than 110 mmHg
• History of myocardial infarction or cerebrovascular event within 3 months
• History of serious hemorrhage (including cerebral hemorrhage) in the past 6 months
• Advanced liver disease
• Ejection fraction less than 30%
• Anticipated live donor kidney transplant
• A history of poor adherence to hemodialysis or medical regimen
• Severe anemia (hemoglobin less than 8 g/dl) requiring blood transfusions
• Use of immunosuppressive drugs within one month before study enrollment
• Active connective tissue disease
• History of acute infections disease within one month before study enrollment
• Inability to provide consent
• Pregnancy