COMPLICATIONS DURING HEMODIALYSIS

Even though the safety of the hemodialytic procedure has improved greatly over the
years, the procedure is not without risks. Common problems are listed below.

Hypotension

A decrease in blood pressure is the most frequent complication reported during

hemodialysis. When fluid is removed during hemodialysis, the osmotic pressure is
increased and this prompts refilling from the interstitial space. The interstitial space is
then refilled by fluid from the intracellular space. Excessive ultrafiltration with
inadequate vascular refilling plays a major role in dialysis induced hypotension. The
immediate treatment to hypotension is to discontinue dialysis and place the patient in a
trendelenburg position. This will increase cardiac filling and may increase the blood
pressure promptly.

Cramps

In the majority of hemodialysis patients, cramps occur toward the end of the dialysis
procedure after a significant volume of fluid has been removed by ultrafiltration. The
immediate treatment for cramps is directed at restoring intravascular volume through the
use of small boluses of isotonic saline. Prevention of cramps has been attempted with the
prophylactic use of quinine sulfate at least 2 hours prior to dialysis.

Febrile reactions

Febrile episodes should be aggressively evaluated with appropriate wound and blood
cultures. The suspicion of infection should be high. Treatment of endotoxin related fever
is generally supportive with antipyretics. Temperatures should be recorded at the
initiation and termination of dialysis treatment.

Arrhythmia

Patients on maintenance hemodialysis are at risk of cardiac arrhythmias. They occur

predominately in association with hemodialysis or may occur in the interdialytic period.
Both acute and chronic alterations in fluid, electrolyte, and acid-base homeostasis may be
arrhythmogenic in these patients.

Hemolysis

Hemolysis may result from a number of biochemical and toxic insults during the dialysis
procedure. The half-life of red blood cells in renal failure patients is approximately one
half to one third of normal and the cells are particularly susceptible to membrane injury.

Hypoxemia
A fall in arterial PO2 is a frequent complication of hemodialysis that occurs in nearly 90%
of patients. The drop ranges from 5 to 35 mm Hg, and reaches its peak between 30 - 60
minutes after beginning dialysis. This is obviously undesirable for patients with
underlying cardiopulmonary disease. Also, patients on mechanical ventilators with
constant minute volume and inspired oxygen concentration can still develop hypoxemia
during hemodialysis.