Dialysis Complications

Basics

Description

Dialysis complications may be:

Vascular access related (infection, bleeding)
Nonvascular access related (hypotension, hyperkalemia)
Peritoneal dialysis (PD) related

Etiology

Vascular access related:
- Infections:
  - Infections (largely access related) are a major cause of death in dialysis patients
  - Often caused by Staphylococcus aureus
  - Can present as a localized infection or systemic
  - Hemodialysis catheters have a 2–3-fold increased risk of infection than the AV fistula or graft
  - Infectious complications include endocarditis, osteomyelitis, spinal epidural abscess, septic arthritis, brain abscess, and septic pulmonary emboli
- AV graft/fistula thrombosis or stenosis:
  - Thrombosis and stenosis are the most common complications of AV access for hemodialysis
  - Must be addressed quickly (within 24 hr) to avoid loss of access site
  - Management is mostly surgical; however, interventional treatment also used
- Bleeding:
  - Aneurysmal formation and/or bacterial infection weaken the vessel wall, increasing the risk for bleeding
  - Bleeding occurs post HD after catheter is disconnected from AV access site
Nonvascular access related:
- Hypotension:
  - Most common nonvascular complication of hemodialysis
  - After dialysis: Often owing to acute decrease in circulating blood volume
  - During dialysis: Hypovolemia (more commonly) or onset of cardiac tamponade owing to compensated effusion suddenly becoming symptomatic after correction of volume overload
  - MI, sepsis, dysrhythmias, hypoxia
  - Hemorrhage secondary to anticoagulation, platelet dysfunction of renal failure
- Shortness of breath:
  - Volume overload
  - Development of dyspnea during dialysis owing to tamponade, pericardial effusion, hemorrhage, anaphylaxis, pulmonary embolism, air embolism
- Chest pain:
  - Ischemic:
    - Dialysis patients are often at high risk for having atherosclerotic disease
    - Dialysis is an acute physiologic stressor with transient hypotension and hypoxemia that increases myocardial oxygen demand
  - Pleuritic:
    - Pericarditis, pulmonary embolism
- Neurologic dysfunction: Disequilibrium syndrome:
  - Rapid decrease in serum osmolality during dialysis leaves brain in comparatively hyperosmolar state
Peritoneal dialysis related:
- Peritonitis:
  - Owing to contamination of peritoneal dialysate or tubing during exchange:
    - This can be from translocation of bacteria from bowel. Perforated viscus can present similarly
  - S. aureus or Staphylococcus epidermidis (70%)
  - A majority of patients received PD will develop at least one episode of peritonitis in their lifetime
- Fibrinous blockage of catheter which results from infection or inflammation

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