Arising from dialysis treatment

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.