**4.5 Managing IHD hypotension**

Intradialytic hypotension is a common complication and can cause further ischemic injury to the recovering kidneys, thereby reducing the probability of renal recovery. Obligate intake in critically ill patients can be high due to nutritional needs and intravenous fluids, which leads to large net UF especially if IHD is performed thrice weekly [74].


**Table 8.**

*Interventions to minimize intradialytic hypotension.*

While patients in shock or with significant instability should be treated with PIRRT or CRRT (according to local availability), various interventions are associated with reduced risk of intradialytic hypotension during IHD (see **Table 8**). For most of them, despite being widely used in clinical practice, there is still a low level of evidence in context of AKI, as most evidence come from the ESRD population.
