Hemodialysis.-Induced Hypotension Therapy for End Stage Kidney Disease

Inclusion Criteria: * Subjects age 18 to 85 years * On thrice-weekly hemodialysis for at least six months * Clinically stable, adequately dialyzed (single-pool Kt/V \> 1.2), with polysulphone membrane for at least three consecutive months before the study * Subjects with pre-dialytic systolic blood pressure between 110 and 170 mmHg. * Subjects with a reduction of systolic blood pressure during hemodialysis equal to or greater than 30 mmHg, with associated symptoms such as nausea, vomiting, muscle cramps, dizziness, or anxiety. * Hypotensive episodes should occur four times or more in four weeks (12 hemodialysis sessions). Exclusion Criteria: * Subjects with intradialytic hypotension that require the use of pharmacological intervention such as midodrine or vasopressin * Subjects with pre-dialytic systolic blood pressure greater than 170 mmHg or diastolic blood pressure greater than 110 mmHg * History of myocardial infarction or cerebrovascular event within 3 months * History of serious hemorrhage (including cerebral hemorrhage) in the past 6 months * Advanced liver disease * Ejection fraction less than 30% * Anticipated live donor kidney transplant * A history of poor adherence to hemodialysis or medical regimen * Severe anemia (hemoglobin less than 8 g/dl) requiring blood transfusions * Use of immunosuppressive drugs within one month before study enrollment * Active connective tissue disease * History of acute infections disease within one month before study enrollment * Inability to provide consent * Pregnancy