Hemodialysis treatment is a procedure that allows you to remove excess fluid and toxins from the body of a patient who has impaired kidney function. In acute or chronic renal failure, the kidneys are not able to remove water and protein metabolism products – urea and creatinine, maintain a stable level of potassium, phosphorus, and acid-base balance of the body. In this case, extracorporeal, i.e. extra renal, removal of unnecessary substances.
The average life expectancy of patients on program hemodialysis is more than 10-15 years. There are cases when patients lived for more than 20 years. In any case, hemodialysis is a serious procedure and is associated with the development of a number of complications. All of them are conditionally divided into early and late. The first is related to the hemodialysis procedure itself. The second group of complications is the result of chronic renal failure. The latter category also includes complications that occur after several years of procedures. Riverside Nephrology Physicians provides the best hemodialysis in USA.
Early complications:
Disequilibrium syndrome – characterized by a loss of spatial orientation and the inability to keep the body in an upright position. Disequilibrium syndrome occurs at the beginning of dialysis treatment and severe uremia. It is based on cerebral edema and the difference in osmolarity of cerebrospinal fluid and blood. Accompanied initially by nausea, vomiting, agitation, followed by loss of consciousness, convulsions. In most cases, after appropriate drug therapy, this syndrome stops.
Decreased blood pressure or hypotension. Occurs in every third patient in the first year of the procedures. It occurs as a result of a decrease in circulating blood volume due to the rapid removal of fluid from the blood, which leads to a decrease in blood pressure.
A decrease in blood pressure may be associated with insufficient vasoconstriction (overheated dialysis solution, food intake – a plethora of internal organs, tissue ischemia, neuropathy – for example, in diabetes mellitus).
Also, a drop in blood pressure may be associated with diastolic myocardial dysfunction due to left ventricular hypertrophy, coronary heart disease, etc., with low cardiac output. Poor myocardial contractility may be due to age, hypertension, atherosclerosis, myocardial calcification, valvular disease, amyloidosis, etc. Rare causes of hypotension include cardiac tamponade, myocardial infarction, occult bleeding, septicemia, arrhythmia, dialyzer reaction, hemolysis, air embolism.
Fever and chills
Fever and chills. May occur due to bacterial infections in dialysis patients, occur more frequently than in the general population, progress more rapidly, and resolve more slowly.
Bacterial infections may be associated with vascular access. The source of bacteremia in 50-80% of cases are infections of the temporary vascular access (the time of using the catheter matters). There may be infections of permanent vascular accesses (infection rates of AV fistulas are lower than those of AV prostheses).
- Also, fever may be due to pyrogenic reactions.
- Neurological disorders: imbalance, dizziness up to nausea, and vomiting. Occur as a result of fluctuations in blood pressure.
- Syndrome of water and electrolyte disorders: weakness, headaches, nausea, convulsions.
- Allergic reactions to dialysis fluid and anticoagulants used during the procedure.
- Acute hemolysis and development of anemia.
Late complications:
In patients on hemodialysis (HD), there are many causes of pruritus. The accumulation of uremic toxins in the blood, contact with synthetic materials during the HD procedure, the use of a significant amount of medications, skin changes, a tendency to infections, and frequent mental disorders create a background for the appearance of uremic itching.
Uremic pruritus is observed in 50-90% of patients on HD and peritoneal dialysis. In 25-33%, itching appears before the start of dialysis treatment, in the rest – on HD, usually after 6 months from its start. Most researchers have not noted an increase in the frequency and intensification of itching with long-term treatment of HD, however, there is also evidence of the effect of duration of treatment. In patients on peritoneal dialysis, itching is somewhat less common.
Uremic pruritus can be intermittent or permanent, localized or generalized. Its intensity varies from occasional discomfort to causing anxiety throughout the day and night. 25-50% of patients complain of generalized itching, the rest – of itching mainly in the back, forearms (more fistulous hand). A certain cyclicity of changes in the intensity of itching was revealed with a maximum during a HD session, a decrease on the next day and an increase during a two-day break between HD sessions.
In some patients (25%), itching is noted only during or immediately after a HD session, and in another 42% of patients, itching reaches its maximum intensity at this time. The state of rest, heat, dry skin, sweating can increase the intensity of itching, and reduce itching by activity, sleep, hot or cold showers, cold.
Pruritus is a common complication of chronic renal failure and dialysis therapy. There are many possible causes of itching. As a result, it is often impossible to determine which factor or group of factors are triggers.
Factors:
- Hyperphosphatemia
- Dialyzer reaction
- Uremic (mixed) polyneuropathy
4.Secondary hyperparathyroidism
- Allergy to medicines (heparin)
- Chronic hepatitis with cholestatic component
- Skin diseases
The basis for the treatment of pruritus is the modeling of an adequate dialysis program, strict adherence to a hypophosphite diet and recommendations for drug correction of calcium-phosphorus metabolism disorders, exclusion from the therapy of drugs that are a possible cause of drug allergies. In addition, we must not forget about the treatment of concomitant somatic pathology and skin diseases of various etiologies.
Restless legs syndrome (RLS) is a subjective complaint that cannot be clarified by objective research. It is observed in patients with uremia, iron deficiency, and during pregnancy. Patients experience an irresistible urge to move their legs, aggravated at rest and at night. This syndrome is observed in 6.6 – 62% of patients receiving long-term hemodialysis, and this group of patients has a higher mortality rate.
The pathogenesis of development is associated with dysfunction of the subcortical areas of the brain, with a violation of the metabolism of iron and dopamine. Anemia, hyperphosphatemia, and psychological factors may also play a role.
All episodes of restless legs syndrome are divided into two groups, depending on the cause. Accordingly, they are distinguished:
-
primary (idiopathic) restless legs syndrome;
-
secondary (symptomatic) restless legs syndrome.
Secondary restless legs syndrome is a consequence of a number of somatic and neurological diseases, the elimination of which leads to the disappearance of symptoms. Among these conditions are more common: chronic renal failure (up to 50% of all cases are accompanied by restless legs syndrome); anemia due to iron deficiency in the body; diabetes; insufficiency of certain vitamins (B1, B12, folic acid) and trace elements (magnesium); amyloidosis; rheumatoid arthritis; cryoglobulinemia; thyroid disease; alcoholism; impaired blood supply to the lower extremities (both arterial and venous problems); radiculopathy; multiple sclerosis; tumors and spinal cord injuries.
- Therapy for secondary RLS is based on the treatment of the causative disease.
- Hepatitis and some other nonspecific infections.
- exchange violations. Among them, the development of amyloidosis of the kidneys is in the first place.
- As a result of the absence of erythropoietin in the blood, which is normally produced by the kidneys.
The development of arterial hypertension. Arterial hypertension in dialysis patients is observed very often: in more than 80% before dialysis therapy, in 60% of patients on hemodialysis for a long time, in 30% of patients on peritoneal dialysis. The causes of AH are as follows:
sodium and water retention due to decreased renal excretion;
the presence of an arteriovenous fistula in patients on hemodialysis and the resulting state of hyper circulation;
- anemia and the associated increase in cardiac output;
- treatment with erythropoietin;
- activation of the sympathoadrenal system;
- an increase in the level of endogenous vasoconstrictor factors (endothelin-1, adrenomedullin, inhibitors of Na + K + -ATPase) and a decrease in the level of vasodilators (NO, vasodilating prostaglandins);
- an increase in the content of intracellular calcium due to an excess of parathyroid hormone;
- nocturnal hypoxemia, sleep apnea.
However, this does not mean that all of the listed complications must necessarily be in every patient. Modern “artificial kidney” devices, qualified personnel make it possible to carry out hemodialysis procedures in the most physiological way and with minimal complications. for more informational blog visit ezpostings.