Acute Complications Associated with Hemodialysis

Liangos, Orfeas; Pereira, Brian J.G.; Jaber, Bertrand L.

doi:10.1016/b978-1-4160-0158-4.50026-4

Cited by 4 publications

(6 citation statements)

References 242 publications

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“…Hemolysis can occur in conjunction with hemodialysis, precipitated by contaminants in the water supply, hypotonic or overheated dialysate, or extracorporeal circuit tubing problems (kinked or manufacturing defects) . Excessive negative access pressure (less than −350 mmHg) has been reported to cause minor hemolysis .…”

Section: Discussionmentioning

confidence: 99%

Blood Transfusions in Dogs and Cats Receiving Hemodialysis: 230 Cases (June 1997–September 2012)

Langston

Cook

Eatroff

et al. 2017

Veterinary Internal Medicne

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BackgroundMultiple factors exist that contribute to anemia in dogs and cats receiving hemodialysis, can necessitate transfusion.ObjectivesTo describe blood product usage in dogs and cats with acute and chronic kidney disease that were treated with intermittent hemodialysis to determine risk factors associated with the requirement for blood product transfusion.Animals83 cats and 147 dogs undergoing renal replacement therapy at the Animal Medical Center for acute or chronic kidney disease.MethodsRetrospective medical record review of all dogs and cats receiving renal replacement therapy for kidney disease, from June 1997 through September 2012.ResultsBlood products (whole blood, packed RBCs, or stromal‐free hemoglobin) were administered to 87% of cats and 32% of dogs. The number of dialysis treatments was associated with the requirement for transfusion in cats (adjusted OR 2.21, 95% CI 1.13, 4.32), but not in dogs (adjusted OR 0.98, 95% CI 0.95, 1.03). Administration of a blood product was associated with a higher likelihood of death in dogs (OR 3.198, 95% CI 1.352, 7.565; P = .0098), but not in cats (OR 1.527, 95% CI 0.5404, 4.317, P = .2).Conclusions and Clinical ImportanceVeterinary hospitals with a hemodialysis unit should have reliable and rapid access to safe blood products in order to meet the needs of dogs and cats receiving dialysis.

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Section: Discussionmentioning

confidence: 99%

Blood Transfusions in Dogs and Cats Receiving Hemodialysis: 230 Cases (June 1997–September 2012)

Langston

Cook

Eatroff

et al. 2017

Veterinary Internal Medicne

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“…The increase in brain osmolality by strong acids could be explained by 2 mechanisms: (a) displacement of intracellularly bound Na + and K + ions from protein anions by H + ions, becoming osmotically active in their free form, and (b) the production per se of increased quantities or organic acids, which may increase intracellular brain osmolality. In any case, whatever the mechanism implied, rapid hemodialysis may lead to increased brain osmolality and cerebral edema 23,24,26–28 …”

Section: Discussionmentioning

confidence: 99%

“…Other studies have reported the use of osmotically active solutes to the dialysate (glucose, glycerol, albumin, urea, fructose, NaCl, or mannitol) 31–33 . The use of prophylactic anticonvulsive medication and intravenous mannitol infusions during hemodialysis remains controversial 27 . Finally, some authors have also suggested to treat severely uremic patients initially with peritoneal dialysis, in which a low peritoneal blood flow is associated with a low urea clearance per period of time 23,24 .…”

Section: Discussionmentioning

confidence: 99%

“…In any case, whatever the mechanism implied, rapid hemodialysis may lead to increased brain osmolality and cerebral edema. 23,24,[26][27][28] Post-dialysis brain swelling has been documented by computed tomography scans in humans with chronic renal failure. 28 Prevention is the main goal when treating patients with severe uremia treated with hemodialysis.…”

Section: Discussionmentioning

confidence: 99%

“…[31][32][33] The use of prophylactic anticonvulsive medication and intravenous mannitol infusions during hemodialysis remains controversial. 27 Finally, some authors have also suggested to treat severely uremic patients initially with peritoneal dialysis, in which a low peritoneal blood flow is associated with a low urea clearance per period of time. 23,24 It may be particularly useful if there is no severe hiperkalemia, severe metabolic acidosis, or other clinical conditions that would strongly favor the use of hemodialysis, as was in our case.…”

Section: Discussionmentioning

confidence: 99%

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Dialysis Disequilibrium Syndrome and other treatment complications of extreme uremia: A rare occurrence yet not vanished

Lopez-Almaraz

Correa‐Rotter

2008

Hemodialysis International

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Severe uremia is now a rare occurrence in most developed nations, and yet is still present in many countries of the world. It includes clinical manifestations such as calciphylaxis and uremic frost, which are now rarely seen. Patients with extremely high levels of blood urea nitrogen (above 175 mg/dL) are at a higher risk of experiencing first-time hemodialysis-related complications, in particular dialysis disequilibrium syndrome (DDS). DDS is a central nervous disorder characterized by a wide variety of neurological symptoms that range from nausea and vomiting to even death due to cerebral edema. There are 2 main theories to explain its pathophysiology: the reverse urea effect, which considers that the shift of urea between brain intracellular space and plasma is not immediate, causing a higher concentration of urea within the brain and leading to cerebral edema. The second theory considers that after hemodialysis, patients have transient paradoxical metabolic acidosis within the central nervous system, displacing Na(+) and K(+) from organic anions, making them osmotically active and again leading to cerebral edema. The main goal is to prevent the occurrence of DDS, for which there are several proposed measures including continuous renal replacement therapies. Once established, treatment should be focused on supportive therapy. Another uncommon phenomenon described in patients who initiate hemodialysis is transient pulmonary leukocyte margination, which in conjunction with an inflammatory milieu, may lead to non-cardiogenic pulmonary edema. We present the case of a young adult with severe uremia who, despite application of recommended measures, developed DDS and non-cardiogenic pulmonary edema.

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Hemodialysis

Langston¹

2011

Nephrology and Urology of Small Animals

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Acute Complications Associated with Hemodialysis

Cited by 4 publications

References 242 publications

Blood Transfusions in Dogs and Cats Receiving Hemodialysis: 230 Cases (June 1997–September 2012)

Blood Transfusions in Dogs and Cats Receiving Hemodialysis: 230 Cases (June 1997–September 2012)

Dialysis Disequilibrium Syndrome and other treatment complications of extreme uremia: A rare occurrence yet not vanished

Hemodialysis

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