透析中低血壓是接受血液透析患者常見的併發症之一，其不僅造成患者主觀症狀，更與死亡率、心血管共病、殘餘腎功能等預後，有顯著相關。透析中低血壓的發生原因源自多重因素，而血中滲透壓快速變化是其中一重要的病生理機制。現今藥物尚無法完全預防透析中低血壓，臨床使用中也同時需要考慮不同品項藥物之副作用；因此，尋求可行替代方案更益重要。以病生理角度而言，已有觀察性研究發現藉由改變血漿滲透壓，能有效反轉透析中低血壓。甘露醇作為高滲透壓溶液，於透析中靜脈注射亦有相關實證可提升血漿滲透壓。甘露醇亦為現今透析起始常用的藥物之一。本文整理現有甘露醇能改善透析中低血壓文獻，評估其對於透析低血壓的效果，以提供臨床使用上甘露醇於透析低血壓預防之立基。

Intradialytic hypotension is a common complication during hemodialysis. The incidence varies from 8 to 40 percent according to different definitions and researches. It may cause symptoms and break medical adhesion. Further, intradialytic hypotension had strong correlation to clinical outcomes, such as overall mortality and cardiovascular mortality. It could also lead to end-organ damage, loss of residual renal function, and cardiovascular comorbidities. Intradialytic hypotension was believed to be contributed from various pathophysiology, such as excess fluid removal, inadequate vascular tone, cardiac output decompensation, or rapid osmotic change. It’s known that maintenance of plasma osmolarity lower the risk of intradialytic hypotension. Plasma osmolarity carries an important role in managing intravascular and interstitial fluid balance. Several therapeutic intervention based on the knowledge above had been applied to reduce the incidence of intradialytic hypotension. Mannitol, an agent increasing serum osmolarity largely, is a common drug which was widely used in medical conditions such as control of high intracranial pressure and prevention of dialytic disequilibrium syndrome. Mannitol administration is able to maintain plasma osmolarity, even during hemodialysis. Moreover, clinical trials of mannitol had showed its effectiveness of prevention of intradialytic hypotension. Besides, other intervention, such as midodrine or reducing efficacy of dialysis, still had their own limitations and adverse effects. Thus, this review on mannitol may offer an additional option for clinician in managing the intractable intradialytic hypotension.