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 mortality in dialysis patients
    • Often caused by Staphylococcus aureus
    • Access-related infections can present as a localized infection or systemic
    • Hemodialysis catheters have a 2–3-fold increased risk of infection than an 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. Must be addressed quickly (within 24 hr) to avoid loss of access site
    • Management is mostly surgical
  • 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: hemodialysis is an acute physiologic stressor often resulting in transient hypotension and hypoxemia that increase myocardial oxygen demand in the large segment of dialysis patients with atherosclerotic disease
    • Arrythmias: ventricular tachycardia or other tachyarrhythmias
    • Pleuritic: pericarditis, pulmonary embolism
  • Neurologic dysfunction: Disequilibrium syndrome:
    • Rapid decrease in serum osmolality during dialysis leaves brain in comparatively hyperosmolar state
• PD 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 receiving PD will develop at least 1 episode of peritonitis in their lifetime
  • Fibrinous blockage of catheter which results from infection or inflammation