arising from dialysis treatment

Last reviewed 01/2018

These include:

  • hypotension - from removal of fluid and alterations in electrolyte balance. It is more common in:
    • the elderly
    • diabetics with peripheral neuropathy
    • patients with pre-existing vascular disease
    • patients receiving anti-hypertensive treatment

  • anaphylactic reactions - from modest respiratory distress to anaphylactic shock; especially with cuprophane membranes

  • hypertension - from salt and water retention. It is more common in:
    • patients prone to hypotension during dialysis - because of difficulty in obtaining adequate asymptomatic fluid loss during dialysis
    • poor compliance with salt and water restriction

  • hyperkalaemia - from poor dietary compliance

  • amyloidosis - possibly from activation of inflammatory mediators during extracorporeal circulation

  • infection - from microbial contamination of vascular access points and the extracorporeal circulation. Gram positive bacteria are common. There is an increased incidence of hepatitis C

  • malnutrition - causes include:
    • loss of amino acids and peptides in the dialysate
    • sodium restriction and poor palatability of diet
    • dialysis induced hypercatabolism
    • social and psychological factors

  • aluminium intoxication - from inadequate filtration of incoming water supply - this is now rare

  • use of calcium-containing phosphate binders - there is study evidence of a higher mortality associated with use of calcium-containing phosphate binders in haemodialysis patients (1)

Reference:

  1. Block GA et al. Mortality effect of coronary calcification and phosphate binder choice in incident hemodialysis patients. Kidney Int. 2007 Mar;71(5):438-41.