What Are the Potential Complications of Hemodialysis?

Hemodialysis complications include acute complications and long-term complications. Acute complications refer to complications that occur during dialysis. They occur quickly and are seriously ill and require emergency treatment. Long-term complications are complications that occur after a long period of dialysis. The onset is slow, but the disease is severe and harmful Larger, need to strengthen prevention and control.

Hemodialysis complications

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Hemodialysis complications include acute complications and long-term complications. Acute complications refer to complications that occur during dialysis. They occur quickly and are seriously ill and require emergency treatment. Long-term complications are complications that occur after a long period of dialysis. The onset is slow, but the disease is severe and harmful. Larger, need to strengthen prevention and control.

First use syndrome

1) The hemodialysis tubing is apt to cause blood loss or even shock. When fixing the tubing, the patient should have room for movement.

2) Patients with air embolism may have chest pain, cough, dyspnea or even death. Once it occurs, the tube should be clamped immediately and the blood pump stopped. The patient should be placed in the left side with the head and chest facing downwards and oxygen inhalation and high pressure if necessary. Oxygen therapy.

3) The dialysis membrane rupture will cause the dialyzer to leak blood. You must replace the dialyzer immediately or stop the hemodialysis.

4) Coagulation in the tubing or dialyzer When the patient's hypotension is too long, the blood flow is slow or heparinization is insufficient, cellulose will be precipitated in the venous expeller, and blood coagulation gradually occurs.

1) Electrolytic acid-base metabolism disorders. Patients with uremia are often in a state of metabolic acidosis because of reduced renal acid secretion. Hyperkalemia is the main adverse reaction of dialysis patients taking ACEI, potassium intake and monitoring of potassium during medication.

2) Cardiovascular complications

a) Dialysis hypotension often occurs in patients who have been on dialysis for many years. The systolic blood pressure during dialysis usually does not exceed 100 mmHg, and the incidence rate is 5% -10%. Old age, excessive ultrafiltration volume, acetate dialysate, high dialysate temperature, poor biocompatibility of the dialysis membrane, hyperphosphatemia and the application of vasodilators are the causes of its occurrence.

b) The causes of dialysis hypertension include increased volume load, increased stroke volume, activation of the renin-angiotensin system, hyperactive sympathetic nerves, and side effects of erythropoietin (EPO). ) Excessive secretion. For dialysis hypertension patients whose hematocrit rises too fast, the amount of EPO should be reduced to avoid the increase in blood viscosity and peripheral vascular resistance. Patients who reach the target of hemoglobin should be replaced with a maintenance dose subcutaneously. For refractory hypertension, double nephrectomy can be considered.

c) Arrhythmias occur in patients with maintenance dialysis for many reasons, including coronary heart disease, heart failure, pericarditis, severe anemia, electrolyte abnormalities, acid-base balance disorders, and secondary hyperparathyroidism.

d) Causes of heart and kidney failure include anemia, impaired glucose tolerance, high blood pressure and hypotension, excessive volume load, arteriovenous fistulas, feeding and metabolic abnormalities.

3) Hematological complications

a) Patients with coagulopathy due to coagulopathy due to abnormal von Willebrand factor and platelet glycoprotein dysfunction, platelet dysfunction, use of anticoagulants and other factors, bleeding can often occur.

b) Patients with anemia maintenance hemodialysis may develop anemia to varying degrees due to factors such as reduced erythropoietin synthesis, anemia, nutritional deficiencies, and the presence of red blood cell growth inhibitory factors in the plasma. Among them, erythropoietin has adverse reactions such as hypercoagulation, hyperkalemia, hypertension, and seizures. Early detection and prevention should be paid attention to.

c) Granulocytes, monocytes, and lymphocytes may be inhibited in patients with low immunity, and the immune system may be low and infection may occur.

4) Neurological complications

5) Bone disease and hyperparathyroidism

6) Metabolic abnormalities and malnutrition in maintenance hemodialysis patients are often in a negative nitrogen balance due to protein synthesis disorders and amino acid loss from the dialysate. Patients may also have disorders of lipid metabolism.

7) Dialysis-related amyloidosis (DRA) is the most common and disabling complication of long-term hemodialysis patients. Among patients over the age of 0 years with maintenance hemodialysis, about 60% of patients have clinical or pathological evidence of DRA, and almost 100% of DRA occurs over 10 years. Amyloid deposition mainly occurs in bones and joints and the surrounding soft tissues, leading to carpal tunnel syndrome and chronic joint disease. Recently, pleural deposition has also been reported. At present, most scholars believe that the duration of hemodialysis patients and the age of patients are the main factors leading to the occurrence of DRA.

8) Hepatitis and other complications such as dialysis ascites, pulmonary edema-acquired renal cysts, and mental disorders ^[1]