Common Complications during Hemodialysis Session; Single Central Experience

Special Article - Hypotension

Austin J Nephrol Hypertens. 2019; 6(1): 1078.

Common Complications during Hemodialysis Session; Single Central Experience

Habas El1*, Rayani A2, Alkanonie W3, Habas A4, Alzoukie E5, Razeik S6, Alhabash B7, Emssade S8, El Marghani A9

¹Consultant Physician, Medical Department, TCH, Tripoli University, Libya

²Consultant Pediatrician, Tripoli University, Libya

³Medical Intensive Care, Medical Department, TCH, Libya

4Medical Department, TCH, Libya

5Medical Department, TCH, Libya

6Medical Intensive Care, Medical Department, TCH, Libya

7Medical Department, Nephrology,TCH, Libya

8Medical Department, TCH, Libya

9Biotechnology Research Center (BTC), Libya

*Corresponding author: Elmukhtar Habas, Medical Department, Tripoli Central Hospital (TCH), Tripoli Medical College, Tripoli University, Libya

Received: December 03, 2018; Accepted: January 11, 2019; Published: January 18, 2019


Background: Hemodialysis (HD) is a renal replacement modality that widely used in End Stage Renal Disease (ESRD) therapy. HD complications occur during HD, post-HD session, and at long term.

Aim of the Study: To assess frequency of common complications that occur during HD-session.

Method and Patients: Study planned to assess the complications happened during HD-session for 335 patients. All patients had been informed about study aim. All patients included had not any evidence of HBV, HCV or HIV infection. Patient had their weight, blood pressure, pulse, Random Blood Sugar (RBS) and body temperature before they sat on HD-bed. Regular checkup of vital signs every 30 minutes. Any change of these parameters were recorded. Other parameters as hypoglycemic feature, hypotension, rigor, hotness and others were noted.

Statistical Analysis: After data collection and arrangement in Excel sheet of Microsoft Office version 16, frequency and average of the parameters are calculated by IBM-SPSS version 25 (SPSS, Chicago, IL, USA) statistical package.

Results: Three hundred thirty-five patients enrolled. They were 132 females and 203 male patients, aged 31- 56 years (48 ± 5.2), and weight range was 51- 76 Kg (66 ± 3.4). There were 156 patients; 46 hypertensive, 62 diabetics, and 48 diabetics and hypertensive. The rest were not hypertensive or diabetic.

Vomiting reported in (61.8%) of patients; during 1st hour, vomiting occurred in (40.9%) of patients. During 2nd and at 3rd hour of HD-session, patients had vomiting almost the same number during this time of HD session. Epigastric pain reported in (26.2%), and vomiting with epigastric pain reported in (11.6%) of patients. Epigastric pain and vomiting with raised pancreatic enzymes reported in (1.8%) of patients.

Low random blood sugar (RBS) reported in (56.4%) patients; during 1st hour (29.2%), only (3.3%) of patients had low RBS with features of hypoglycemia. During the 2nd hour of the HD-session (15.8%) had low RBS and (2.3%) had clinical feature of hypoglycemia. During 3rd hour of HD-session, (11.3%) of patients had RBS = 60mg/dl, only (1.8%) of patients had clinical features of hypoglycemia.

Hotness and normal body temperature noticed in (30.4%) of patients. Hotness with increased body temperature without shivering reported (4.5%), hotness, shivering and increased body temperature reported in (14%) of patients.

During the 1st half an hour 15.2%, 2nd hour, 12.5% of patients, last 45 minutes (8.3%) of patients had hypotension. Tachycardia reported in (28%) of patients. Chest pain reported in (2.2%) of patients, and only (2%) of patients had ECG changes suggestive ischemic changes. Only (1.5%) of patients had cardiac arrest. Tachypnea reported in (12.2%).

Patients had HD-session via fistula were (41.7%) of patients. Six patients had hematoma, two patients had infected fistula site. Other 193 had double lumens HD-catheter, (24.3%) had permanent catheter, (75.7%) had temporary HD-catheter. Evidence of infection as redness, discharge, pain reported. Fever and rigor reported in (26.7%) patients. One, two lumens block reported in (8.9%), (6.2%) respectively.

Conclusion: Vomiting is the commonest complication and low RBS. Hotness and hypotension were not also uncommon. Early start of HD, better control of dialysate temperature, strict infection control, and regular vital signs on short time basis and using glucose containing dialysate solutions are major issues to minimize these acute HD complications.

Keywords: Hemodialysis complications; Intradialytic; Vomiting; Hypoglycemia; Hypotension


ESRD is prevalent disease worldwide. A major public health problem can lead to considerable co-morbidity and mortality, and high expenditure by health services providers. Regular HD is the commonest mode of renal replacement treatment in comparison with peritoneal dialysis and renal transplantation all over the world [1,2]. It has been also reported by Blagg 2001, and Habas et al. 2012 that more than 500.000 patients worldwide, and about 250.000 patients in USA were on regular HD, and most of ESRD patients have three session of HD per week [3,4]. It had been estimated that at 2010, HDdependent patients were about two million [5], and at 2030, more than two million patients will be HD dependent ESRD [6].

Patients on regular HD develop many complications during the session of HD (Intradialytic), post-HD session, and have long-term complications [3,4]. The most common intradialytic complications of HD are, hypotension, vomiting, epigastric pain, hypoglycemia, chest pain, tachycardia, muscle cramps, cardiac arrest, shivering, hotness, epistasis, melena, hallucination, restlessness leg, allergic reaction and jaw lock [2].

In Libya, about 4000 patients have regular HD, while HD is the primary renal replacement therapy available in this country [7].

Up to our knowledge, there was not any study conducted to assess complications that occur during HD session. Therefore, this study was planned to assess the common complications occurring during HD session in patients on regular hemodialysis for more than three months and less than nine months.

Statistical Analysis

Data were collected and arranged at Excel sheet of Microsoft Excel version 16 program. The statistical analysis was conducted by IBM-SPSS version 25 (SPSS, Chicago, IL, USA) statistical package.

Method and Patients

Three hundred thirty-five patient enrolled in this study. All patients were ESRD on regular HD more than 3 months and less than nine months, mostly three sessions per week. They were 132 females and 203 male patients (Figure 1). Their age average 48 ± 5.2 (sem) with a range of 31 to 56 years. Weight average was 66 Kg ± 3.4 with a range of 51-76 Kg. one hundred and six patients either hypertensive, diabetic or both diabetic and hypertensive (46, 62, 48 patients) respectively, 170 patients were not hypertensive or diabetic. All patients had 3 hours’ HD session with mean of inter-dialytic weight increase of 2.3 ± 5.4 Kg.