Maintaining end stage kidney disease patients on regular hemodialysis is usually associated with many acute complications
Maintaining end stage kidney disease patients on regular hemodialysis is usually associated with many acute complications. They include hypotension (low blood pressure), cramps, nausea and vomiting, headache, acute chest pain, low back pain, pruritus (itching), pyrexia (fever) and chills. The underlying mechanisms of these events that occur during dialysis are not clearly recognized.
With prolonged time of the dialysis session or an increased amount of fluid removal (called ultrafiltration), certain acute complications will emerge, such as headache, nausea, and vomiting will be more frequent within dialysis session. A new patient who started dialysis for the first time may develop certain syndrome called “disequilibrium syndrome” that occur due to rapid removal of the uremic toxins (toxins of renal failure). A variant related to this syndrome may explain the aforementioned complications, particularly so in non-compliant or poorly dialyzed patients who are amenable for aggressive courses of intense dialysis.
The occurrence of chest pain during the dialysis session may be attributed to either hypotension (low blood pressure) or to an underlying disequilibrium syndrome (see above). Other possible causes may include angina pectoris, hemolytic events, and the rare air embolism (air inside blood vessel). Moreover, despite pulmonary embolism is a very rare event in patients on dialysis, this event may be observed with manipulation of a thrombus (clot) inside a vessel or if the patient’s dialysis access has been occluded. Management of chest pain during dialysis depends to a great extent on its impact on patient’s circulation, if the patient is hemodynamically unstable or has a positive history of ischemic heart disease or via clinical examination, return of blood and cessation of dialysis session may allow better management. Acutely, the decision to continue or stop the dialysis treatment because of chest pain is based upon clinical findings, such as hemodynamic stability, and the results of the history and physical examination.