Dialysis Complications
Basics
Description
Dialysis complications may be:Description
- Vascular access related (infection, bleeding)
- Nonvascular access related (hypotension, hyperkalemia)
- Peritoneal dialysis (PD) related
Etiology
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
- Infections:
- 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
- Ischemic:
- Neurologic dysfunction: Disequilibrium syndrome:
- Rapid decrease in serum osmolality during dialysis leaves brain in comparatively hyperosmolar state
- Hypotension:
- 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
- Owing to contamination of peritoneal dialysate or tubing during exchange:
- Fibrinous blockage of catheter which results from infection or inflammation
- Peritonitis:
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Citation
Schaider, Jeffrey J., et al., editors. "Dialysis Complications." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307541/all/Dialysis_Complications.
Dialysis Complications. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307541/all/Dialysis_Complications. Accessed December 1, 2024.
Dialysis Complications. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307541/all/Dialysis_Complications
Dialysis Complications [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 01]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307541/all/Dialysis_Complications.
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