Edgar V. Lerma πŸ‡΅πŸ‡­ Profile picture
Aug 18, 2019 β€’ 16 tweets β€’ 16 min read β€’ Read on X
Hemodialysis 101: Complications
πŸ“Œ Intradialytic Hypotension
πŸ“Œ Muscle Cramps
πŸ“Œ Nausea and Vomiting
πŸ“Œ Pruritus
πŸ“Œ Dysequilibrium Syndrome
πŸ“Œ Dialyzer Reactions
πŸ“Œ Hemolysis
πŸ“Œ Air Embolism
#Nephpearls #DialysisDirector Image
Intradialytic Hypotension (IDH): Nadir SBP < 90 πŸ‘‰πŸΌ strongest association with ⬆️ mortality
πŸ“Œ Poor long-term Outcomes
πŸ“Œ ⬆️ mortality
πŸ“Œ Myocardial stunning
πŸ“Œ Incidence is highest in those with low pre-HD BP
πŸ“Œ ⬆️ risk of access thrombosis
#Nephpearls #DialysisDirector ImageImage
Intradialytic Hypotension (IDH): Strategies to help prevent Hypotension during dialysis #Nephpearls #DialysisDirector Image
Muscle Cramps with hemodialysis
πŸ“Œ More common during 1st month of dialysis
πŸ“Œ More common in those with low cardiac index
πŸ“Œ Consider ⬇️ Mg, ⬇️ Ca, ⬇️ K
πŸ“Œ Risks: Hypotension, Hypovolemia, ⬆️ UF rate, ⬇️ Dialysate Na
#Nephpearls #DialysisDirector
πŸ‘‰πŸΌ google.com/amp/s/www.huff… Image
Quinine sulfate before dialysis, though effective in preventing intradialytic cramps, is now considered inadvisable because of its association with -
πŸ“Œ Thrombocytopenia
πŸ“Œ Hypersensitivity reactions
πŸ“Œ QT prolongation
#Nephpearls #DialysisDirector Image
Pruritus Treatment algorithm for patients on hemodialysis from @BCRenalAgency
#Nephpearls #DialysisDirector
πŸ‘‰πŸΌ bcrenalagency.ca/resource-galle… Image
Short-term (6 weeks) use of sertraline reduces IDH in some patients
πŸ“Œ β€œPossible” mechanism: Sertraline-induced attenuation of the paradoxical sympathetic withdrawal that may underlie IDH in some patients w/ ESKD
#Nephpearls #DialysisDirector
πŸ‘‰πŸΌ ajkd.org/article/S0272-… ImageImageImageImage
Therapeutic algorithm in CKD associated pruritus ca. 2013 from @Kidney_Int
#Nephpearls #DialysisDirector
πŸ‘‰πŸΌ kidney-international.org/article/S0085-… ImageImage
Dysequilbrium Syndrome
πŸ“Œ Acute ⬆️ in brain water content
πŸ‘‰πŸΌ When plasma solute level is rapidly ⬇️ during HD, plasma becomes hypotonic relative to brain cells & water shifts from plasma into brain tissue
πŸ“Œ Acute changes in CSF pH during dialysis
#Nephpearls #DialysisDirector ImageImage
Preventing Dysequilibrium Syndrome in the setting of acute dialysis
πŸ“Œ Target reduction in the BUN should initially be limited to about 40%
πŸ“Œ Low Dialysate Na (more than 2–3 mmol < Serum Na) may exacerbate cerebral edema and should be avoided
#Nephpearls #DialysisDirector Image
Preventing Dysequilibrium Syndrome in the setting of chronic dialysis
πŸ“Œ Use of dialysate Na at least 140 mmol
πŸ“Œ Use of high dialysate Na (145–150 mmol) that declines over the course of treatment for patients has been advocated in this setting
#Nephpearls #DialysisDirector Image
Dialyzer reactions
πŸ“Œ Type A - Anaplylactic
πŸ”² Ethylene oxide
πŸ”² AN69-associated
πŸ”² Contaminated dialysate
πŸ”² Reuse
πŸ”² Heparin
πŸ”² Complement fragment release
πŸ”² Eosinophilia

πŸ“Œ Type B
πŸ”² Complement activation ⁉️

#Nephpearls #DialysisDirector
πŸ‘‰πŸΌ cjasn.asnjournals.org/content/clinja… ImageImage
Hemolysis with HD
πŸ“Œ Obstruction or narrowing in the blood line, catheter, or needle - KINK⁉️
πŸ“Œ Problem w/ dialysate
πŸ”² Overheated dialysate
πŸ”² Hypotonic dialysate
πŸ”² Contaminated dialysate (formaldehyde, bleach, Cu, etc)
#Nephpearls #DialysisDirector
πŸ‘‰πŸΌ cjasn.asnjournals.org/content/clinja… ImageImage
Venous air embolism may arise from possible areas of air entry into the dialysis circuit
πŸ“Œ Foam in the venous blood line
πŸ“Œ If air has gone into the heart, a peculiar churning sound may be heard on auscultation
#Nephpearls #DialysisDirector
πŸ‘‰πŸΌ cjasn.asnjournals.org/content/clinja… ImageImage
Management 🚨 of venous air embolism during HD
1️⃣ Clamp πŸ—œ the venous blood line & stop the blood pump‼️
2️⃣ Place patient in the recumbent position on the left side w/ the chest & head tilted downward
➑️ Cardiopulmonary support, 100% O2, etc.
#Nephpearls #DialysisDirector Image
KALM-1: Efficacy and Safety of Difelikefalin in Patients Undergoing Hemodialysis with Pruritus: Results from a Phase 3 Randomized, Controlled Study
#KidneyWk #Nephpearls
πŸ‘‰πŸΌ nejm.org/doi/pdf/10.105… ImageImageImageImage

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