Intradialytic Hypertension


  • Genetic predisposition
  • Pre existing hypertension
  • Extracellular volume excess
  • Increased renin- angiotensin system activity (possibly in the presence of increased   sodium overload)
  • Increased sympathetic activity
  • Increased endothelin-1 to nitric oxide ratio
  • Uremic toxins (ADMA)
  • Blood hyperviscosity
  • Correction of hypoxia- induced vasoconstriction
  • Increased dialysate sodium
  • Secondary hyperparathyroidism

Treatment  and Prevention

  • Lifestyle modifications such as weight reduction, dietary modification, sodium restriction, physical activity and moderation of alcohol consumption can reduce systolic blood pressure from 2-14 mm Hg1
  • Adjustment of target weight on a regular basis. Gradual reduction of interdialytic weight gain over a few weeks using zero sodium balance, salt restriction, longer dialysis or extra dialysis sessions may yield a significant benefit2
  • Reducing erythropoeitin dose in patients with severe hypertension and withholding of anti-hypertensive medications on the day of dialysis
  • Nephrectomy in resistant cases
  • Renal transplantation or conversion to PD


  1. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ; National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee. Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 289:2560-2572, 2003.
  2. Charra B. ‘Dry weight’ in dialysis: the history of a concept. Nephrol Dial Transplant. 13:1882-1885, 1998