Pharmacologic options available to treat symptomatic intradialytic hypotension

Treatment of symptomatic intradialytic hypotension (IDH) is a difficult tas k for the practicing nephrologist. Minimizing patient factors that precipit ate IDH as well as dialysis procedure-related components that lower blood p ressure are the initial approaches to this problem. However, despite these maneuvers, hypotension often persists in a group of high-risk patients. Pha rmacologic interventions are often used to reduce IDH. Unfortunately, many of the available therapies are marginally effective and/or poorly tolerated . A few therapies appear to be efficacious and well tolerated-carnitine, se rtraline, and midodrine. This article reviews the various pharmacologic the rapies used for IDH and makes recommendations for treatment of this difficu lt problem. (C) 2001 by the National Kidney Foundation, Inc.