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| *[[Dialysis-associated hypotension]]
| | {{Dialysis complications DDX}} |
| *[[Dialysis disequilibrium syndrome]]
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| *[[Air embolism]]
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| ==Vascular Access Complications==
| | {{AV shunt complications DDX}} |
| ===Thrombosis and Stenosis===
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| *Most common causes of inadequate dialysis flow
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| **Loss of bruit and thrill over access
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| *Stenosis and even thrombosis are not emergencies
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| **Can be treated w/in 24hr by angiographic clot removal or angioplasty
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| **Thrombosis of vascular access can be treated w/ direct injection of alteplase 2.2mg
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| ***This therapy should be discussed with the vascular surgeon first
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| ===Infection=== | | ===Peritoneal Dialysis Complications=== |
| *Pts often p/w signs of systemic [[sepsis]] ([[fever]], [[hypotension]], leukocytosis) | | *[[Peritoneal dialysis-associated peritonitis]] |
| **Classic signs of pain, erythema, swelling, d/c from infected access are often missing
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| *Dialysis catheter–related bacteremia is common and potentially life-threatening
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| **Give [[vancomycin]] 1gm IV +/- genamicin 100mg IV (if gram neg suspected)
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| **Do not remove dialysis patient's access
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| *Draw peripheral and catheter [[blood cultures]] simultaneously
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| **4x higher colony count in catheter blood cx suggests catheter is source of bacteremia
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| ***Even so catheter is only removed if fever persists for 2-3d after abx are started
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| ===Hemorrhage===
| | {{ESRD Associated Skin Conditions}} |
| *Potentially life-threatening
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| *Can result from aneurysms, anastomosis rupture, or over-anticoagulation
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| *Control bleeding w/ pressure applied to puncture site for 5-10min; observee for 1-2hr
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| *Types
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| **Aneursym (true)
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| ***Most are asymptomatic; rarely rupture
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| **Pseudoaneurysm
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| ***Results from subcutaneous extravasation of blood from puncture sites
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| ***Bleeding from puncture site is usually controlled by digital pressure or subq suture
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| ***Consider vascular surgery consultation for continued bleeding or infection
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| ***Arterial Doppler US studies can identify the aneurysm or pseudoaneurysm
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| ===Vascular insufficiency===
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| *Distal extremity becomes ischemic due shunting of arterial blood to venous side
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| **Exercise pain, nonhealing ulcers, cool, pulseless digits
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| **Diagnosed by Doppler US or angiography, repaired surgically
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| ===High-output heart failure===
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| *Occurs when >20% of cardiac output is diverted through the access
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| **Branham sign (drop in HR after temporary access occlusion) is diagnostic
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| **Doppler US can accurately measure access flow rate and establish the diagnosis
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| **Tx = surgical banding of the access
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| ==Peritoneal Dialysis Complications== | | ===[[Altered Mental Status]]=== |
| ===Peritonitis===
| | *[[Hypotension]] |
| ====Background====
| | *[[Hypoglycemia]] |
| *Most common complication | | *[[Hypercalcemia]] / [[Hyperkalemia]] / [[Hyponatremia]] |
| *Presentation no different from other causes of peritonitis | | *[[Subdural hematoma]] |
| ====Diagnosis====
| | *[[Dysequilibrium syndrome]] - diagnosis of exclusion made after admission |
| *Send dialysate fluid for cell count, Gram stain, cx (if available) | |
| **Cell count >100 w/ >50% neutrophils most c/w infection
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| ====Treatment====
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| *Can add [[antibiotic] to the dialysate if possible (parenteral abx not required)
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| **1st gen [[cephalosporin]] or [[vancomycin]] (if pen allergic) | |
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| ==Source== | | ==References== |
| Tintinalli
| | <references/> |
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| [[Category:Nephro]] | | [[Category:Renal]] |
| | [[Category:Vascular]] |
