Renal dialysis complications

1. Sumathi Chinnadurai
29 May 2014

2.  DEFINITION
 EPIDEMIOLOGY
 TYPES OF DIALYSIS
 INDICATIONS OF DIALYSIS
 COMPLICATIONS OF DIALYSIS

3. • DIALYSIS is a form of renal replacement
therapy in patients with end stage renal
disease.
- To remove nitrogenous end products
- Correct salts, water and acid-base
imbalance.
- It does not correct the endocrine
dysfunction of the diseased kidney

4.  There are currently 20,766 people in Australia who are
on renal replacement therapy.1
 Currently, the three most common causes of kidney
disease requiring kidney replacement therapy in
Australia are diabetes, glomerulonephritis and
hypertension.1
 Dialysis treatment was the number one reason for
hospitalisation in 2009-10, making up over 1.1 million
hospitalisations, or 13% of the total hospitalisations for
this period.2
1. State of the nation, CKD in Australia, May 2014
2. AIHW - Dialysis and kidney transplantation in Australia: 1991-2010

5. HEMODIALYSIS
•Intermittent Renal Replacement Therapy
(Intermittent Hemodialysis)
•Sustained Low efficiency Dialysis
•Continous Renal Replacement Therapy
( CVVHD, CVVHF, CVVHDF, SCUF)
PERITONEAL DIALYSIS
CAPD, CCPD, NIDF

7.  Acidemia
 Fluid overload with anuria or oliguria
 Electrolyte disturbance
 Urea> 35 mmol/l
 Creatinine>400micromol/l
 Toxins

8. • Empirically when GFR< 10ml/min/1.73m2
or GFR< 15ml/min/1.73 m2 in diabetics.
• IDEAL STUDY - Early vs Late initiation of
Dialysis
• Often when symptomatic(uraemic)
- Nausea, vomiting, Anorexia, fatigability,
confusion

9. Urgently when signs of uremia
•Pericarditis
•Refractory Pulmonary edema
•Refractory hyperkalemia
•Metabolic acidosis
•Asterexis
•Peripheral neuropathy/foot drop/wrist
drop

10. • Hypotension: occurs in 25-50% due to
Excessive ultrafiltration
- cardiac arrhythmias, IHD, air embolus,
pericardial tamponade;
- Haemorrhage – Gastric ulcer,
Intracranial bleed, retroperitoneal bleed
Sepsis
Anaphylaxis.

11.  Muscle cramps: 15-20%
 Nausea and Vomiting: 5-15%
- prolonged treatment times and /or
ultrafiltration with excess solute removal.
 Disequilibrium Syndrome: occurs in first
few dialysis sessions in elderly frail pts.
Cerebral oedema due to excessive urea
removal from bld than CSF resulting in osmotic
gradient fluid shift

12.  Heamolysis
 Bleeding – excessive heparin.
 Fever –Bacteremia, overheated dialysate.
 Seizure – Excessive Urea clearance, failure of
dialysis conc delivery system.
 Air Embolism
 Amyloidosis – Inadequate clearance of B2-
microglobulins using low permeability
cellulose dialysis membrane.

13. • Access problems
• AV Fistula – Thrombosis, Infection, Finger
ischaemia.
• Hickman line, Vascular catheters –
Thrombosis, bleeding, Infection.

14. • Bladder perforation on insertion of PD
catheter
• Peritonitis especially in CAPD
>100cells/microl
• Tunnel abscess & Pericatheter infections
– also a common source of peritonitis
• Umbilical hernia

15.  Sclerosing encapsulated peritonitis /
Encapsulating peritoneal sclerosis
Inflammatory stage – Fever, ^CRP, mild
ileus,Incrsing ascites. Rx with Methylpred
Encapsulating stage- If early stage not
relieved or reccurs <1mnth. Rx with TPN
and decrease steroid
Ileus stage – If Ileus symptoms persist
despite absence of inflammatory signs &
ascites. Rx with laporotomy and

16.  Prompt recognition of diagnosis is
essential.
 Hypotension is most common
presentation.
 There is an overlap of symptoms/signs in
various complications.