Abstract: Chronic kidney disease represents a major global public health challenge.Patients in the uremic stage often require renal replacement therapy,however,the incidence of hypotension during treatment remains high,which can lead to hypoperfusion of vital organs and increase the risk of mortality.The traditional blood pressure-centered reactive management model urgently needs to shift toward proactive prevention.This review systematically elaborates that the root cause of hypotension lies in imprecise volume assessment and individualized physiological imbalances in patients. Non-invasive technologies, such as bioelectrical impedance analysis,online blood volume monitoring,inferior vena cava ultrasonography,and non-invasive cardiac output monitoring,provide key tools for early risk warning.Based on a systematic synthesis of existing evidence,this review integrates and proposes a theoretical framework for graded nursing intervention centered on precise volume assessment and spanning the entire treatment process.The framework clarifies the critical role and implementation pathway of nursing in the paradigm shift from "reactive management"to"proactive early warning and prevention",offering clear guidance for future clinical practice and research.