A STUDY OF COMPLICATIONS ENCOUNTERED IN PATIENTS UNDERGOING HEMODIALYSIS PROCEDURE

Syed Marghoob Hasan 1 , * Himanshu Devender Kumar 1 , P K Prasher 1 and Richa Goel 2 . 1. Department of Medicine, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Haryana, India 133207. 2. Department of Biochemistry, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Haryana, India 133207. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History


ISSN: 2320-5407
Int. J. Adv. Res. 5 (11), 877-884 878 and electrolyte imbalances. The lives of many patients with ESRD are prolonged with relief of symptoms if hemodialysis is done at right or appropriate time when needed.
Hemodialysis is a life-saving procedure routinely done for ESRD for the last 35 years. (1) The patients who require hemodialysis are more likely to have cerebrovascular disease, cardiovascular disease and perivascular disease and chronic obstructive pulmonary disease. Hemodialysis is a safe procedure with an estimated death of 1 in total 75000 treatments occurs due to the technical error. However, there are numerous complications which are related to hemodialysis, some of them are life-threatening. (Prabhakar, Singh, Singh, Rathore, & Choudhary, 2015) The frequency and severity of the complications usually depend upon the underlying condition of patients who are going for hemodialysis such as diabetes mellitus, coronary artery disease, hypertension, congestive cardiac failure and the patient's degree of compliance with a complex medical regimen. Allergic reaction to dialyzer membranes, sterilizing and reprocessing agents and contaminated dialysate related complications were very common in early days of hemodialysis. (Davenport, 2006) Materials and method The present study was conducted in the Department of Medicine at M.M. Institute of Medical Sciences and Research, Mullana, Haryana. Seven hundred forty patients undergoing hemodialysis at dialysis unit due to acute kidney injury (AKI), chronic kidney disease (CKD), acid-base balance, or any other cause were included in the study after informed and written consent. Patients were selected via purposive sampling method. There were no exclusion criteria. All patients were subjected to detailed history, clinical examination and appropriate biochemical evaluation. Complications encountered were divided into three groups: patient-related complication, technical complications, and vascular access-related complications. Appropriate management was provided to the patients whenever complication occurred. The approval of study was obtained from the Institutional Ethical Committee. Data was compiled and appropriate statistical analysis was done.
Complications were grouped into three categories:

Discussion:-
Increased frequency and severity of hypotension, muscle cramps, headache, and the dialysis disequilibrium syndrome is observed these days because of faster and more aggressive UF with shorter dialysis times. To counteract this, dialysate sodium concentration can be increased. This could be achieved by maintaining higher sodium dialysate concentration for the entire duration of hemodialysis, infusions of 0.9% saline or hypertonic saline, or altering the dialysate Na concentration over the course of the hemodialysis session (Na modeling). Ideally, the changes in plasma sodium should be limited to 4-5 mEq/L. (Golper et al., 2014) The potential benefits include a reduced incidence of dialysis disequilibrium, vascular instability, and muscle cramps.
The incidence of hypotension in the dialysis population ranges between 15% and 30%, being more common in women and the elderly. (Phoon, 2012) In our study most common complication encountered was the hypotensive episode which may be directly related to decreasing blood volume or to a decrease in cardiovascular activation as a response to the decreased cardiac filling. Hypotension results when the rate of intravascular volume removal exceeds its rate of refilling, especially if total peripheral resistance cannot compensate for the loss of intravascular volume. (Nette et al., 2005) Diabetic nephropathy is another cause of hypotension or risk factor for hypotension in patients undergoing hemodialysis. (Flynn III, 1996) Intradialytic hypertension is the third most common complications which occur during hemodialysis procedure has been recognized for many years. (Levin, 1993) In our study, 24.7 % had intradialytic hypertension.
In the study of Chang & Tan, it is clearly stated that nausea and vomiting are common complications during hemodialysis, an incidence of nausea and vomiting are reported as 18.2% and 9.8% respectively, (Chong & Tan, 2013) the occurrence of nausea and vomiting is mainly due to rapid fall of blood pressure and urea during hemodialysis.
The headache came to be second most frequent complications which may be caused due to shifting of the large amount of water and electrolytes during hemodialysis procedure. the commonest feature of a headache which was observed are frontotemporal in location, moderate in severity, pain is of short duration <4 hours and of throbbing type.(Göksan, Karaali-Savrun, Ertan, & Savrun, 2004) Muscle cramps occur in as many as 20% of dialysis treatments but our study recorded only 5.5%. Although their pathogenesis is uncertain, cramps are known to be more frequent when UFRs are high and when low Na dialysate is employed, suggesting a volume related etiology. (Golper et al., 2014) Patients with ESRD frequently have left ventricular hypertrophy, coronary artery and pericardial disease, and valvular sclerosis. (Singh et al., 2014) In our study, 27 patients experienced chest pain during hemodialysis although no mortality was seen. The conduction system may be affected by calcific deposits particularly in patients wit h the adynamic bone disease. Superimposed upon these pathologies are the rapid changes in electrolyte concentrations inherent in the hemodialysis. It is not surprising that hemodialysis may provoke cardiac arrhythmias.

Conclusions:-
Hemodialysis is associated with a vivid number of complications some are even life-threatening, however strict monitoring proper assessment of patients and good clinical acumen may help in early detection and early management without the termination of life-saving procedures. Longer, slower dialysis treatments and shorter, more frequent dialysis treatments make possible removal of larger amounts of fluid during the week without the patient experiencing as much hypotension and cramping.