Symptomatic hypotension during (or immediately following) hemodialysis complicates 5 to 30
percent of all dialysis treatments and is associated with increased morbidity and mortality.
Kidney Disease Outcomes Quality Initiative (KDOQI) and European Best Practice Guidelines
define intradialytic hypotension as the presence of a decrease in systolic blood pressure ≥20
mmHg or a decrease in mean arterial pressure by 10 mmHg, providing the decrease in blood
pressure is associated with clinical events and need for nursing interventions. Common causes
of intradialytic hypotension include excessive or rapid ultrafiltration, high blood flow
during dialysis, CHF, taking the antihypertensive medications prior to HD, and others. One of
the possible reasons that is surprisingly has not been approached worldwide for
intra-dialytic hypotension could be more prevalent adrenal insufficiency in ESRD patients or
a delay in the appropriate rise of endogenous serum cortisol given hemodialysis is considered
by all means a stressful condition to the body. Investigators will assess first the
prevalence of intradialytic hypotension at JUH dialysis unit. Investigators will screen
patients who developed intradialytic hypotension for adrenal insufficiency by ordering random
am cortisol. Then Investigators will give IV Hydrocortisone 100 mg prior to HD to patients
who developed intra-dialytic hypotension and monitor their BP response during the HD
treatments for 3 HD sessions (1 week, 3 HD sessions). After that, the same patients will
receive 100 mg normal saline for 3 HD sessions. Both the administrator and the patient will
be blinded for the interventions.