Intradialytic Complications Found in Patients at a Tertiary Care Hospital

Research Article

Austin J Pharmacol Ther. 2016; 4(1).1079.

Intradialytic Complications Found in Patients at a Tertiary Care Hospital

Mehmood Y¹*, Ghafoor S², Ashraf MI³, Riaz H4, Atif SR4 and Saeed M5

1Faculty of Pharmacy, University of Central Punjab, Pakistan

2Department of Chemistry, GC University, Pakistan

3Pharmacology Department, Rashid Latif Medical College, Pakistan

4Rashid Latif College of Pharmacy, Pakistan

5Department of Pharmacy, Riphah International University, Pakistan

*Corresponding author: :Yasir Mehmood, Faculty of Pharmacy, University of Central Punjab, Pakistan

Received: December 20, 2015; Accepted: March 01, 2016; Published: March 04, 2016


Introduction: Hemodialysis is a continuous process completed in almost 4 hours. During this procedure toxic substances are removed from the body by simple diffusion technique through a dialysis machine. During the procedure a lot of changes in the fluid and mineral compartment occur due to which patients suffer from various complications. The aim of the study was to observe those complications and their management. Services hospital Lahore was selected for this study and a convenience sampling technique was used for collecting data.

Methods: A cross-sectional study was conducted at Nephrology unit of a tertiary care hospital from 15 June, 2014 to 15 December, 2014. A total of 40 patients on regular hemodialysis were included in the study. Patients with acute renal failure were excluded from the study.

Results: Most commonly observed complication were hypotension 37.5%, Cramps 12.5%, Itching 15%, Vomiting 22.5% and dialysis reaction 5%. Normal saline and 5% dextrose were used for managing the complications. For dialyzer reaction hydrocortisone Sodium Succinate was given stat intravenously and session was postponed. Hemodialysis is a not totally risk free although it is beneficial for saving patient life.

Conclusion: Although intradialytic complications are life threatening but they are manageable and their frequency is low.

Keywords: Hemodialysis; Vomiting; Dialysis; Complications


Hemodialysis is a method of removing toxic substances (impurities or wastes) from the blood when the kidneys are unable to do so [1]. Dialysis is from Greek word “dialusis” mean dissolution, “dia” meaning through, and “lusis” mean loosening [2].

It removes waste products such as potassium and urea [3], and free water from the blood when the kidneys are unable to do so in renal failure. Other renal replacement therapies are renal transplant and peritoneal dialysis.

When kidneys stop working hemodialysis replaces most of their filtration function [4]. Hemodialysis removes those substances from blood which could cause death if kidneys stop working [4]. Since hemodialysis is not a constant process, it cannot monitor body functions as do normal kidneys [5], but it can eliminate waste products and restore electrolyte and pH levels when hemodialysis session is done.

The basic principle of hemodialysis is diffusion across a semi permeable membrane [6]. Hemodialysis utilizes a diffusion mechanism called counter current flow, where the dialysate flow in the opposite direction to blood flow the extracorporeal circuit. Counter-current flow maintains the concentration gradient across the membrane at a maximum and increases the efficiency of the hemodialysis [6].

Fluids are removed (ultra filtration) by applying hydrostatic pressure in the dialysate compartment, causing free water and some dissolved solutes to move out [7]. The dialysis solution used is a sterilized solution of mineral ions. Urea and other waste products, potassium, and phosphate diffuse into the dialysis solution. However, concentrations of sodium and chloride are kept similar to those of normal plasma to prevent loss [8]. sodium bicarbonate is added in a higher concentration than plasma to correct the blood acidity. In hemodialysis, three primary methods are used to gain access to the blood: and I/V catheter, an Arteriovenous (AV) fistula and a synthetic graft [9]. The type of access is influenced by factors such as the expected time course of a patient’s renal failure and the condition of his or her vasculature. Patients may have multiple accesses, usually because an AV fistula or graft is maturing and a catheter is still being in use [10].

Most preferred method is AV (Arteriovenous) fistula. For creating AV fistula a vascular surgeon joins an artery and a vein together through anastomosis. This junction bypasses the capillaries and blood flows rapidly through the fistula. Its advantages are lower risk of infection and thrombosis [11]. An AV fistula takes about 6 month to mature from surgery to first dialysis. If a fistula has a very high blood flow a Steal syndrome can occur. Where the blood not enters the limbs and circulate between fistula and general circulation. This results in cold extremities cramping pain and severe tissue damage (Figure 1).