Preventing Intradialytic Hypotension: Translating Evidence into Practice

Intradialytic hypotension (IDH) remains the most frequent severe side effect of hemodialysis. This prospective, exploratory study aimed to measure the compliance of an IDH prevention pathway and to identify the effects of pathway use on hypotension incidence. Additionally, the study explored barriers and facilitators to pathway implementation in five hemodialysis centers. Instituting an ultrafiltration pause decreased the odds of hypotensive episodes by 44% (OR = 0.56, 95% CI = 0.20 to 1.56, χ2 1 = 1.25, p = 0.26); however, audits indicated that mean compliance with the pathway (n = 2,711) was only 34%. Focus group interviews revealed nurse concern regarding lack of education prior to pathway implementation and patient apprehension at ultrafiltration pausing without symptoms. This highlights the importance of active translational strategies for clinicians to optimize clinical outcomes in reducing hypotension incidence.