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It can provoke hypovolemic stress, leading to myocardial stunning, cerebral ischemia, and organ dysfunction. This review analyzes clinical relevance, mechanisms, and risk factors, and promotes standardized definitions and future research directions. Management focuses on individualized strategies (optimised UFR, cooled dialysate, and nutrition) plus emerging technologies for real-time risk prediction, supported by multidisciplinary 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Manuscript: [https://www.f6publishing.com](https://www.f6publishing.com) World J Nephrol 2025 December 25; 14(4): 109168  \nDOI: 10.5527/wjn.v14.i4.109168 ISSN 2220-6124 (online)  \nREVIEW  \nUpdates in the management of intradialytic hypotension: Emerging strategies and innovations  \nIntissar Haddiya, Gregorius Diel Franta Iogi Simanjuntak, Sara Ramdani  \nSpecialty type: Urology and nephrology  \nProvenance and peer review:  \nInvited article; Externally peer reviewed.  \nPeer-review model: Single blind  \nPeer-review report’s classification Scientific Quality: Grade B  \nNovelty: Grade A  \nCreativity or Innovation: Grade B  \nScientific Significance: Grade B  \nP-Reviewer: Feng SM, MD, Professor, China  \nReceived: May 8, 2025  \nRevised: June 17, 2025  \nAccepted: September 17, 2025  \nPublished online: December 25, 2025  \nProcessing time: 229 Days and 21.9 Hours  \nIntissar Haddiya, Department of Nephrology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda-Angad 60049, Oriental, Morocco  \nIntissar Haddiya, Sara Ramdani, Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, OujdaAngad 60049, Oriental, Morocco  \nGregorius Diel Franta Iogi Simanjuntak, Faculty of Medicine, University of Riau, Pekanbaru 28133, Riau, Indonesia  \nCorresponding author: Sara Ramdani, PhD, Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Hayal Hikma, Oujda-Angad 60049, Oriental, [Morocco.](Morocco. sara.ramdani001@gmail.com)[ sara.ramdani001@gmail.com](Morocco. sara.ramdani001@gmail.com)  \nAbstract  \nIntradialytic hypotension (IDH) is a prevalent and critical complication of haemodialysis associated with significant morbidity, mortality, and reduced quality of life in end-stage renal disease patients. IDH results from multifactorial interactions, including excessive ultrafiltration rates (UFR), rapid osmotic shifts, impaired vascular resistance, and comorbidities such as diabetes and cardiovascular disease. It triggers hypovolemic stress, leading to myocardial stunning, cerebral ischemia, and organ dysfunction. Non-modifiable risk factors, including age and preexisting conditions, exacerbate susceptibility, while modifiable elements such as high interdialytic weight gain and improper dialysis prescriptions worsen outcomes. In this review, we aim to conduct an in-depth analysis of IDH, exploring its clinical relevance, underlying mechanisms, risk factors, and management approaches. Additionally, we advocate for a standardised definition and propose a strategic framework to guide future research efforts. Effective management requires individualised approaches, including optimised UFR, cooled dialysate, and nutritional adjustments, alongside emerging technologies like bio-impedance spectroscopy and artificial intelligence for real-time risk prediction. A multidisciplinary team approach, incorporating nephrologists, nurses, and dietitians, is essential for holistic patient care. Future research and technological advancements hold promise for mitigating IDH’s clinical and systemic impact, ultimately improving patient outcomes and survival.  \nKey Words: Intradialytic hypotension; Haemodialysis; Ultrafiltration rates; Osmotic shifts;  \n WJN  [https://www.wjgnet.com](https://www.wjgnet.com) 1 December 25, 2025  Volume 14  Issue 4   \nHaddiya I et al. Updates of intradialytic hypotension management  \nManagement strategies  \n©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.  \nCore Tip: Intradialytic hypotension remains a critical complication in haemodialysis, lacking a universal definition and significantly impacting patient morbidity and mortality. This comprehensive review elucidates the complex interplay of its pathophysiology, ","cbCaieaod7deWOjL","https://ap.wps.com/l/cbCaieaod7deWOjL","pdf",777747,"English","# Abstract\n# Core Tip\n# Introduction\n## Epidemiology and outcomes\n# Management strategies","[{\"question\":\"What causes intradialytic hypotension during haemodialysis?\",\"answer\":\"IDH results from multifactorial interactions such as excessive ultrafiltration rates, rapid osmotic shifts, impaired vascular resistance, and comorbidities including diabetes and cardiovascular disease.\"},{\"question\":\"Why is intradialytic hypotension clinically important?\",\"answer\":\"IDH is linked to severe consequences including myocardial stunning, cerebral ischemia, organ dysfunction, vascular access complications, cardiac events, and higher mortality.\"},{\"question\":\"How can intradialytic hypotension be managed according to the review?\",\"answer\":\"Effective care requires individualized approaches using optimized ultrafiltration rates, cooled dialysate, and nutritional adjustments, supported by emerging technologies for real-time risk prediction and multidisciplinary teamwork.\"}]","Updates in the management of intradialytic hypotension: Emerging strategies and innovations | PDF",1790567888,48]