Francisco Chacón-Lozsán: Intermittent Hemodialysis in the ICU Should not be Monitored Only by ‘Session Completed’
Francisco Chacón-Lozsán, Fellow at World Extreme Medicine, Member of European Society of Intensive Care Medicine (ESICM) and American College of Cardiology, shared a post on LinkedIn:
“Intermittent hemodialysis in the ICU should not be monitored only by ‘session completed’.
It is a dynamic therapy that can correct life threatening physiology or destabilize the patient.
Key parameters to monitor:
- Before dialysis: MAP, vasopressor dose, fluid balance, pulmonary edema, potassium, bicarbonate, pH, urea, creatinine, sodium, calcium, phosphate, temperature, ECG, access function and bleeding risk.
- During dialysis: blood pressure trend, arrhythmias, ultrafiltration rate, blood flow, venous and arterial pressures, dialysate prescription, symptoms, circuit clotting, delivered time, relative blood volume when available, and signs of disequilibrium.
- After dialysis: potassium rebound, pH correction, sodium/osmolality shift, net fluid removed, hemodynamic recovery, oxygenation, mental status and need for the next session.
Interpretation matters.
Hypotension during IHD is not benign.
It may mean excessive ultrafiltration, preload dependence, sepsis vasoplegia, poor cardiac reserve, myocardial stunning, bleeding, tamponade, arrhythmia or dialyzer reaction.
If MAP falls, stop or reduce UF, give fluid only if truly preload responsive, lower blood flow temporarily, cool dialysate, reassess potassium bath, vasopressor support and consider SLED or CRRT if instability persists.
If potassium remains high, increase treatment time, frequency, dialysate flow or use a lower potassium bath carefully.
If acidosis persists, reassess bicarbonate bath, delivered time, ongoing shock and lactate production.
If pulmonary edema persists, the issue is often insufficient safe net ultrafiltration, not ‘dialysis failure.’
If the circuit clots, review access, blood flow, filtration conditions and anticoagulation strategy.
References
- Chan, R. J., Helmeczi, W., Canney, M., & Clark, E. G. (2023). Management of intermittent hemodialysis in the critically ill patient. Clinical Journal of the American Society of Nephrology, 18(2), 245–255.
- Hammal, F., et al. (2026). Key performance indicators for acute intermittent renal replacement therapy in critically ill patients: A systematic review. Blood Purification.
- Lyrio, R. M. C., et al. (2024). Predictors of intradialytic hypotension in critically ill patients undergoing kidney replacement therapy: A systematic review. Intensive Care Medicine Experimental, 12, 96.
- Meersch-Dini, M., et al. (2026). Multidisciplinary guidelines on renal replacement therapy in critically ill patients with acute kidney injury. Intensive Care Medicine. PMID: 41535953
- Martin, M., Bansal, A., Perez, L., Stenson, E. K., & Kendrick, J. (2022). Use of relative blood volume monitoring to reduce intradialytic hypotension in hospitalized patients receiving dialysis. Kidney International Reports, 7(9), 2027–2035.”
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