Hypertension is common in chronic kidney disease patients especially in those undergoing hemodialysis (HD).
Usually, blood pressure falls after the HD session but in some patients a paradoxical increase has been observed during or
immediately after HD. This phenomenon is referred as intradialytic hypertension. HD patients with intradialytic
hypertension or increased blood pressure during HD present higher cardiovascular (CV) morbidity and mortality rates.
The underlying mechanism of intradialytic hypertension is multifactorial. Activation both of renin-angiotensinaldosterone
system (RAAS) and sympathetic nervous system, volume and sodium overload with concomitant increase in
cardiac output, and endothelial dysfunction have been implicated in the pathogenesis of intradialytic hypertension. Given
the lack of clinical trials regarding the pathophysiology and management of intradialytic hypertension, current treatment
strategies are based mainly on experts’ opinion. The purpose of this review is to describe the pathophysiology of
intradialytic hypertension and discuss current strategies in order to improve intradialytic blood pressure management and
concomitant HD patients’ outcomes.
Keywords: Hemodialysis, intradialytic hypertension, mortality, overhydration, pathogenesis, sodium overload.
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