Evidence summaries of prevention and management of intradialytic hypotension

WAN Xingyu; ZHUANG Ruo; ZHU Liqun; ZHOU Yan; LIU Yi; XIA Lei; BAO Lei; GONG Huifang; YE Wei

doi:10.12102/j.issn.2095-8668.2023.23.007

Abstract：Objective:To summarize the best evidence for prevention and management of hypotension in maintenance hemodialysis patients,in order to provide references for medical staff to carry out clinical evidence-based practice.Methods:Relevant evidence-based databases and professional association websites in both Chinese and English were retrieved for IDH related thematic evidence summaries,clinical practice guidelines,system evaluations,evidence summaries,and expert consensus.The retrieval time was from the inception to April 2022.Four researchers evaluated the retrieved guidelines,and three researchers evaluated the rest of the literature.Evidence was extracted and integrated for the literature that met the quality standards.Results:A total of 15 articles were included,including 1 clinical decision,3 guidelines,6 systematic reviews,2 evidence summary,1 industry standard,and 2 expert consensuses.Summarize the evidence of 29 items in 8 aspects,including basic characteristics,risk assessment,organizational construction,third-line prevention plan,supplementary preventive measures,whole process blood pressure monitoring,and emergency management.Conclusion:Medical institutions should establish management standards for the prevention of hypotension during dialysis in hemodialysis patients based on evidence.It is recommended that medical staff implement a step-by-step third-line prevention plan and auxiliary preventive measures according to the relevant risk factors of patients.At the same time,blood pressure monitoring should be done throughout the whole process to detect hypotension in dialysis in time,so as to deal with it scientifically and quickly to reduce the harm caused by it and ensure the patient's safety.