Background: Intradialytic hypotension (IDH) is considered to be a frequent complication of hemodialysis (HD) and is associated with symptom burden, increased incidence of access failure, cardiovascular events, and higher mortality. This systematic literature review aims to analyse studies that investigated the prevalence of IDH. A complicating factor herein is that many different definitions of IDH are used in literature. Methods: A systematic literature search from databases, Medline, Cinahl, EMBASE, and the Cochrane library to identify studies reporting on the actual prevalence of IDH was conducted. Studies were categorized by the type of definition used for the prevalence of IDH. A meta-analysis of the prevalence of IDH was performed. Results: In a meta-analysis comprising 4 studies including 1,694 patients and 4 studies including 13,189 patients, the prevalence of HD sessions complicated by IDH was 10.1 and 11.6% for the European Best Practice Guideline (EBPG) definition and the Nadir <90 definition, respectively. The proportion of patients with frequent IDH could not reliably be established because of the wide range in cutoff values that were used to identify patients with frequent IDH. There was a large variety in the prevalence of symptoms and interventions. Major risk factors associated with IDH across studies were diabetes, a higher interdialytic weight gain, female gender, and lower body weight. Conclusion: Our meta-analysis suggests that the prevalence of IDH is lower than 12% for both the EBPG and the Nadir <90 definition which is much lower than stated in most reviews.

Despite major improvements in drug output of new nebulizers and differences between nebulizers [1], doses of albuterol nebulizing therapy of hospitalized COPD‐patients has not changed in the last decades. The objective was to determine the optimal dose in the current setting according to a standardized protocol (10 min at flow 8 l min−1, MICRO MIST nebulizer, Hudson RCI). After a washout of bronchodilators patients nebulized 5 mg (group A; n=21. FEV1=47.4 ± 2.9% predicted; Tiffeneau=48.1 ± 2.5%) or 10 mg (group B; n=21, FEV1=50.5 ± 3.8% predicted; Tiffeneau=49.5 ± 3.4%) albuterol (t=−10 to 0 min). Pulmonary function (PF) (FEV1, FVC, Tiffeneau), dyspnoea (modified Borg scale) and heart‐frequency (HF), blood pressure (BP), breathing‐frequency (BF), serum potassium (K), fingertremor, QTc‐interval, were measured at t=−30, 10, 30, 60, 120, 240 min. Charcoal was administered to prevent gastrointestinal absorption (t=−10; 10 min (5 g) and 60 min (10 g). Pharmacodynamic (PD)‐effects, relative to baseline, and correlation between effects, severeness of COPD and patient characteristics were analysed. FEV1 and FVC increased significantly (FEV1: (A) 10–120 min; (B) 10–240 min; Figure 1), leaving Tiffeneau unchanged. FVC at t=10 is significantly greater for group B compared to A (P=0.009). PD‐parameters (Table 1) showed significant changes. Figure 1  Mean FEV1, FVC in groups A and B. ⧫▵ FEV, A, ▪▵ FEV, B, ▴▵ FVCA, *▵ FVCB. PD‐parameter differences relative to t=−30 min, group A and B t=10 t=30 t=60 t=120 t=240 ΔHF (beats min−1)A4.1±1.5^6.0±1.9*^7.8±2.0*8.5±1.9*4.2±1.4*B12.5±2.6*15.1±3.0*14.0±2.4*10.0±2.0*7.6±2.3*ΔQTc (ms)A8.3±4.0*^6.5±9.0^28.2±8.0*14.3±6.0*7.3±4.7B26.0±6.0*30.7±6.0*20.0±6.8*16.5±5.6*18.0±6.3*ΔK+ (mmol l−1)A−0.1±0.1−0.2±0.0*−0.5±0.1*−0.2±0.1−0.1±0.1*B−0.2±0.1*−0.5±0.1*−0.3±0.1*−0.3±0.1*−0.1±0.1 * Significant within group; ^ significant between groups; P<0.05. All changes in group B had an earlier onset and were of the same or longer duration. Parameters not mentioned did not change clinically significant. FEV1‐ and dyspnoeic‐changes and FEV1 and FVC changes had a significant correlation in both groups. No other correlations or differences were seen. Group B shows no greater PF improvements, only significant and clinical relevant greater changes in some side effects. In moderate to severe COPD‐patients 5 mg albuterol is the highest recommended dose, lower doses should be investigated.