Dialysis Complications

Dialysis Complications is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

Dialysis complications may be:
  • Vascular access related (infection, bleeding)
  • Nonvascular access related (hypotension, hyperkalemia)
  • Peritoneal (abdominal pain, infection)

Etiology

  • Vascular access related:
    • Infections:
      • Infections (largely access related or peritonitis) are a major cause of death in dialysis patients.
      • Often caused by Staphylococcus aureus
      • Can present with signs of localized infection or systemic sepsis
      • Can also present with minimal findings
    • Thrombosis or stenosis:
      • Often presents with loss of bruit or thrill over access site
      • Must be addressed quickly (within 24 hr) to avoid loss of access site
    • Bleeding:
      • Can be life-threatening
      • Aneurysm
  • Nonvascular access related:
    • Hypotension:
      • Most common 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:
    • Peritonitis:
      • Owing to contamination of peritoneal dialysate or tubing during exchange
      • S. aureus or Staphylococcus epidermidis (70%)
    • Perforated viscus with abdominal pain that can be severe, fever, brown or fecal material in effluent, or localized tenderness
    • Fibrinous blockage of catheter resulting from infection or inflammation

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Basics

Description

Dialysis complications may be:
  • Vascular access related (infection, bleeding)
  • Nonvascular access related (hypotension, hyperkalemia)
  • Peritoneal (abdominal pain, infection)

Etiology

  • Vascular access related:
    • Infections:
      • Infections (largely access related or peritonitis) are a major cause of death in dialysis patients.
      • Often caused by Staphylococcus aureus
      • Can present with signs of localized infection or systemic sepsis
      • Can also present with minimal findings
    • Thrombosis or stenosis:
      • Often presents with loss of bruit or thrill over access site
      • Must be addressed quickly (within 24 hr) to avoid loss of access site
    • Bleeding:
      • Can be life-threatening
      • Aneurysm
  • Nonvascular access related:
    • Hypotension:
      • Most common 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:
    • Peritonitis:
      • Owing to contamination of peritoneal dialysate or tubing during exchange
      • S. aureus or Staphylococcus epidermidis (70%)
    • Perforated viscus with abdominal pain that can be severe, fever, brown or fecal material in effluent, or localized tenderness
    • Fibrinous blockage of catheter resulting from infection or inflammation

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