Prevention and Management of Cardiovascular and Cerebrovascular Complications in Maintenance Hemodialysis (MHD) Patients

Inclusion Criteria

• •1. Age between 18 and 80 years.
• •2. Receiving maintenance hemodialysis (MHD) for 3 months or longer.
• •3. Diagnosis of severe ultrafiltration intolerance (UFI), defined as either:
• •Persistent pre-dialysis hypotension (systolic blood pressure \<100 mmHg), OR
• •Recurrent intradialytic hypotension (IDH), defined per KDOQI guidelines as a decrease in systolic blood pressure to \<90 mmHg or by \>20 mmHg from baseline, accompanied by symptoms.
• •4. Failure to achieve target ultrafiltration volume (mean UFV \<1.5 L per session) despite at least 4 weeks of conventional interventions (e.g., dialysate cooling, sodium profiling, sequential ultrafiltration).
• •5. Inadequate dialysis delivery, defined as a mean single-pool Kt/V of less than 1.2.