Dialysis Complications

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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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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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