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Complications during Hemodialysis

Hypotension is the most common acute complication of hemodialysis, particularly among diabetics. Numerous factors ap hypotension, including excessive ultrafiltration with inadequate compensatory vascular filling, impaired vasoactive or au osmolar shifts, overzealous use of antihypertensive agents, and reduced cardiac reserve. Patients with arteriovenous fis develop high output cardiac failure due to shunting of blood through the dialysis access; on rare occasions, this may nec fistula or graft. Because of the vasodilatory and cardiodepressive effects of acetate, its use as the buffer in dialysate wa hypotension. Since the introduction of bicarbonate-containing dialysate, dialysis-associated hypotension has become les management of hypotension during dialysis consists of discontinuing ultrafiltration, the administration of 100 23% saturated hypertonic saline, and administration of salt-poor albumin. Hypotension during dialysis can frequently be evaluation of the dry weight and by ultrafiltration modeling, such that more fluid is removed at the beginning rather tha procedure. Additional maneuvers include the performance of sequential ultrafiltration followed by dialysis; the use of mi adrenergic pressor agent; cooling of the dialysate during dialysis treatment; and avoiding heavy meals during dialysis. Muscle cramps during dialysis are also a common complication of the procedure. The etiology of dialysis-associated cram Changes in muscle perfusion because of excessively aggressive volume removal, particularly below the estimated dry w sodium-containing dialysate, have been proposed as precipitants of dialysis-associated cramps. Strategies that may be include reducing volume removal during dialysis, ultrafiltration profiling, and the use of higher concentrations of sodium modeling (see above).

Anaphylactoid reactions to the dialyzer, particularly on its first use, have been reported most frequently with the bioinco containing membranes. With the gradual phasing out of cuprophane membranes in the United States, dialyzer reactions uncommon. Dialyzer reactions can be divided into two types, A and B. Type A reactions are attributed to an IgE hypersensitivity reaction to ethylene oxide used in the sterilization of new dialyzers. This reaction typically occurs soon a treatment (within the first few minutes) and can progress to full-blown anaphylaxis if the therapy is not promptly discon steroids or epinephrine may be needed if symptoms are severe. The type B reaction consists of a symptom complex of n pain, which appears to result from complement activation and cytokine release. These symptoms typically occur several run and typically resolve over time with continued dialysis.

diseases constitute the major causes of death in patients with ESRD. Cardiovascular mortality and event patients than in patients posttransplantation, although rates are extraordinarily high in both populations. The underlying disease is unclear but may be related to shared risk factors (e.g., diabetes mellitus), chronic inflammation, massive cha volume (especially with high interdialytic weight gains), inadequate treatment of hypertension, dyslipidemia, anemia, dy calcification, hyperhomocysteinemia, and, perhaps, alterations in cardiovascular dynamics during the dialysis treatment cardiovascular risk reduction in ESRD patients; none have demonstrated consistent benefit. Nevertheless, most experts cardioprotective strategies (e.g., lipid-lowering agents, aspirin, -adrenergic antagonists) in dialysis patients based on t risk profile, which appears to be increased by more than an order of magnitude relative to persons unaffected by kidney