Dialysis Complications
Dialysis Complications is a topic covered in the 5-Minute Emergency Consult.
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Basics
Description
Dialysis complications may be:Description
- Vascular access related (infection, bleeding)
- Nonvascular access related (hypotension, hyperkalemia)
- Peritoneal (abdominal pain, infection)
Etiology
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
- Infections:
- 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
- Ischemic:
- Neurologic dysfunction: Disequilibrium syndrome:
- Rapid decrease in serum osmolality during dialysis leaves brain in comparatively hyperosmolar state.
- Hypotension:
- 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
- Peritonitis:
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Citation
Rosen, Peter, et al., editors. "Dialysis Complications." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307541/all/Dialysis_Complications.
Dialysis Complications. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307541/all/Dialysis_Complications. Accessed December 9, 2019.
Dialysis Complications. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307541/all/Dialysis_Complications
Dialysis Complications [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 December 09]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307541/all/Dialysis_Complications.
* Article titles in AMA citation format should be in sentence-case
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