What is the most likely cause of hypotension in a 64-year-old diabetic during dialysis?

Hypotension in a patient undergoing dialysis can often be attributed to fluid loss. During dialysis, especially hemodialysis, excess fluid is removed from the body to help manage fluid overload that can occur in patients with kidney failure. This process can lead to a significant decrease in blood volume, particularly in older adults or those with pre-existing conditions like diabetes, making them more susceptible to drops in blood pressure.

Additionally, the removal of fluid can lead to a rapid change in the hemodynamic state, which may not be well tolerated by a patient with underlying issues such as compromised cardiovascular health. In the case of a 64-year-old diabetic during dialysis, the combination of their age, diabetes, and potential for poor volume status makes fluid loss the most plausible cause of hypotension.

Other factors like medication side effects, cardiac dysfunction, and infection can contribute to hypotension, but fluid loss during dialysis is especially significant and frequently the primary concern when monitoring patients in this setting.