View source for Dialysis complications

==Background==
*Dialysis patients are high-acuity ED patients with unique complications
*Common presentations: access problems, hypotension, electrolyte emergencies, infections
*Always check when last dialysis session was and if any were missed

==Hemodialysis Complications==
{{Dialysis complications DDX}}

===Access Complications===
{{AV shunt complications DDX}}
*Thrombosed fistula/graft: absent thrill/bruit → vascular surgery referral within 24-48h
*Hemorrhage from access site: direct pressure x 10-15 min; avoid tourniquet proximal to access
*Infection: erythema, warmth, purulent drainage → blood cultures + empiric [[vancomycin]]; avoid using infected access
*Steal syndrome: hand ischemia distal to fistula (pain, pallor, cool fingers) → vascular surgery

===During/Post-Dialysis===
*Hypotension: most common acute complication; give NS bolus (avoid excessive fluid in volume-overloaded patient)
*[[Dysequilibrium syndrome]]: headache, N/V, AMS, seizures during/after dialysis (especially first sessions) — diagnosis of exclusion after ruling out other AMS causes
*Air embolism: rare but catastrophic; place in left lateral decubitus/Trendelenburg
*Muscle cramps: NS bolus, reduce ultrafiltration rate

===Missed Dialysis===
*'''[[Hyperkalemia]]''': most immediately life-threatening — ECG, calcium, insulin/glucose, kayexalate, emergent dialysis
*Volume overload / [[pulmonary edema]]: BiPAP, [[nitroglycerin]], [[furosemide]] (limited efficacy in anuric patients), emergent dialysis
*[[Uremic pericarditis]]: friction rub, emergent dialysis; avoid anticoagulation (hemorrhagic risk)
*Metabolic acidosis

==Peritoneal Dialysis Complications==
*[[Peritoneal dialysis-associated peritonitis]]: cloudy effluent, abdominal pain, fever
**Send peritoneal fluid for cell count, Gram stain, culture
**Empiric intraperitoneal antibiotics (vancomycin + ceftazidime or gentamicin)
*Catheter malposition, obstruction, leakage
*Exit site/tunnel infection: erythema, drainage at catheter site

==Altered Mental Status in Dialysis Patients==
*[[Hypotension]]
*[[Hypoglycemia]]
*[[Hypercalcemia]] / [[Hyperkalemia]] / [[Hyponatremia]]
*[[Subdural hematoma]] (from anticoagulation during dialysis)
*[[Dysequilibrium syndrome]] - diagnosis of exclusion made after admission
*[[Stroke]]
*[[Uremia]] (inadequate dialysis)
*Medication accumulation (renally cleared drugs)
*Sepsis

{{ESRD Associated Skin Conditions}}

==Evaluation==
*[[ECG]] (hyperkalemia changes — peaked T waves, widened QRS)
*[[BMP]]: K, Ca, BUN, Cr, glucose
*[[CBC]], blood cultures if febrile
*[[CXR]]: pulmonary edema, line placement
*Access exam: check thrill/bruit

==Disposition==
*Low threshold for admission — these are high-risk patients
*Admit: missed dialysis with hyperkalemia or volume overload, access infection, peritonitis, AMS, new arrhythmia
*Arrange emergent dialysis for: severe hyperkalemia, pulmonary edema, uremic pericarditis
*Discharge only for minor issues with ensured follow-up at dialysis center

==See Also==
*[[Hyperkalemia]]
*[[Peritoneal dialysis-associated peritonitis]]
*[[Chronic kidney disease]]

==References==
<references/>

[[Category:Renal]]
[[Category:Vascular]]