Acute Complications of Hemodialysis

Abstract

Chronic kidney disease (CKD) is a common public health problem, which occurs in many countries with an increasing prevalence. Over 50 million people throughout the world are known to have CKD, and of these, more than 1 million require renal replacement therapies such as dialysis and renal transplantation. In recent years , the rising incidence of diabetes and hypertension, the most common two causes of CKD, cause an increase in the prevalence of CKD. Hemodialysis, which is one of the renal replacement therapies, is a life-saving treatment. In the absence of this therapy, more than a million patients worldwide would have died within weeks. Hemodialysis was successfully performed for the first time in 1944 by Willem Kollf in patients with renal failure. However, hemodialysis is accompanied by several complications. During the first years following the introduction of hemodialysis, complications were common due to the technical drawbacks associated with the dialysis machines and water systems. Currently, the advances in technology, particularly those in the last 20 years, have reduced the complications. However, complications caused by the reasons other than the dialysis machine and water system remain as a significant cause of morbidity and mortality in hemodialysis patients. Cardiovascular complications are currently the most common complication of hemodialysis. Among these complications, the rate of symptomatic intradialytic hypotension ranges between 20% and 50%, and it remains an important problem (Cruz DN et al., 1997). Another concern is the hemodialysis-associated arrhythmias, the rate of which was reported to be 5% to 75%. The common and lethal types of arrhythmias include ventricular arrhythmias and ectopies. The rate of hemodialysis-associated complex ventricular arrhythmia is around 35% (Burton JO et al., 2008). The second most common type of arrhythmia is the atrial fibrillation, the rate of which is 27% (Genovesi S et al., 2008). Sudden cardiac death accounts for 62% of cardiac-related deaths and it is usually attributed to arrhythmias (Herzog CA et al., 2008). The first year of hemodialysis is of vital importance with respect to sudden cardiac deaths, which was determined in 93 of 1000 patients in the first year of hemodialysis (Shastri S et al., 2010). While cramps were observed in 24%-86% of the cases during the first years following the introduction of dialysis therapy, recently it has been shown that only 2% of the patients having ≥2 hemodialysis sessions in a week suffer from cramps (Kobrin SM et al., 2007). Other common complications include nausea, vomiting with a rate of 5%-15%, headache with a rate of 5%-10% and itching with a rate of 5%-10%( Jesus AC et al., 2009; Mettang T et al., 2002). Although cramps, nausea-vomiting, headache and itching do not result in mortality, they substantially deteriorate the quality of life of the patients. Although more