Complications are prone to hemodialysis

Patients on dialysis often lose blood pressure, cramps, nausea, headache; Rarely, anaphylactic membrane reaction can cause cardiac arrest, death.

Doctor Huynh Thi Nguyen Nghia, Head of the Department of Renal Dialysis, Nguyen Tri Phuong Hospital, said that common complications in hemodialysis are 20-30% blood pressure, cramps (5-20%), nausea and vomiting (5-15%). About 5% of patients have headaches, 2-5% of chest pain and some less itching and chills.

Hypotension

Most patients feel dizzy, dizzy or nauseous when blood pressure drops occur. Some suffer from cramps. Others may have discreet symptoms, which can only be seen by medical staff familiar with the patient, such as loss of consciousness, dark feeling. In some patients, there are no symptoms until the blood pressure drops very low, very dangerous.

In order to avoid hypotension, patients do not gain much weight between dialysis sessions, ideally less than one kilogram per day. Salt intake should be limited because eating salt will cause thirst, which will cause excess salt and water and make weight gain quickly and much.

Patients who easily lose blood pressure during dialysis should avoid eating immediately before or during dialysis. Eating during dialysis can boost or increase the risk of hypotension. The reason is due to dilating blood vessels in the digestive system, increasing blood capacity in the digestive system vein, making blood flow to the heart worse. The effect on blood pressure of food lasts about 2 hours.

People who often lose blood pressure during hemodialysis should avoid taking blood pressure medication before dialysis.

Cramp

The cause of cramps in hemodialysis is unknown. The most common cramps are associated with hypotension, although cramps often persist after the blood pressure has fully recovered. Cramps are more common in the first month of dialysis than in later stages.

Prevention of hypotension will eliminate most cramps. Stretching exercises, muscle stretch programs for muscle cramps can be helpful.

Hemodialysis patients.(Artwork: Le Phuong).

Nausea and vomiting

Nausea and vomiting occur up to 10% of routine dialysis. In stable patients, most are due to hypotension. This may also have early symptoms of imbalance syndrome.

As a precaution, avoid hypotension during dialysis. Persistent symptoms unrelated to hemodynamics may decrease when anti-emetic drugs are used.

Headache

The cause of a headache is often unknown. In patients who drink coffee, headache can be a symptom of cessation of coffee because the concentration of coffee decreases acutely during dialysis. With atypical or too severe headache, it is possible to consider the neurological cause, especially the haemorrhage promoted by anticoagulants.

Chest pain and back pain

Light chest pain or discomfort in the chest, often more or less with back pain is currently unknown, no specific management or prevention.

Itching

Pruritus is sometimes boosted or aggravated by dialysis. Pruritus occurs only in dialysis, especially if there are other mild allergy symptoms, which may be a symptom of mild allergy to the filter or dialysis component. Itching can also be caused by viral hepatitis or by drugs.

Some complications are rare but serious

Imbalance syndrome

This is a group of systemic and neurological symptoms often associated with specific signs on the EEG, which can occur during or after dialysis. Early symptoms include nausea, vomiting, irritability and headache. More serious symptoms include seizures, dizziness and coma.

Membrane reaction

Type A (anaphylactic type)

Symptoms of dyspnea, feeling near death, hot. Cardiac arrest and even death may occur. Mild cases may indicate symptoms of itching, hives, coughing, sneezing, runny or runny eyes. Gastrointestinal symptoms such as abdominal cramps or diarrhea may also occur. Symptoms usually begin within minutes after dialysis, but sometimes can be within 30 minutes or more.

The cause is often caused by reaction with residual ethylene oxide from the filter, contaminated filtrate, re-use the filter .

Type B membrane reaction is not specific

The main symptoms of a type B reaction are chest pain, sometimes with back pain. Starting symptoms usually 20-40 minutes after starting dialysis.

Arrhythmia

Renal arrhythmias are common, especially in patients taking digitalis and patients with coronary artery disease.

Pinched heart

Sudden drop in blood pressure or recurrence in dialysis may be a sign of an imminent effusion or cardiac tamponade.

Intracranial hemorrhage

Background vascular disease and hypertension associated with heparin can sometimes cause intracranial, subarachnoid or subdural hemorrhage during dialysis sessions.

Convulsions

Children and patients with high blood urea levels prior to dialysis and patients with severe hypertension are the most likely to have seizures in dialysis. Seizures may be a symptom of an imbalance syndrome.

Hemolysis

Acute hemolysis in dialysis may be a medical emergency. Symptoms include back pain, chest pain and difficulty breathing. Without detection and early treatment can cause muscle weakness, electrocardiographic abnormalities, cardiac arrest.

Airway embolism

Air embolism is a potential disaster that can be fatal if not detected and treated quickly. In sitting patients, air tends to enter the brain vein without entering the heart, causing obstruction of the brain veins, causing coma, convulsions, and even death. In lying patients, air tends to enter the heart, creating foam in the right ventricle, going into the lungs, causing difficulty in breathing, coughing, severe chest and arrhythmia.

Vision loss and hearing loss

Transient blindness in patients with glaucoma and endothelial hearing loss in the inner ear has been reported to occur during dialysis. Hypotension during dialysis or unrelated vascular events may also alter vision and hearing function.