Early Outcomes In Patients Newly Initiated On Hemodialysis

Renal replacement therapies include hemodialysis, peritoneal dialysis and Renal transplant. Hemodialysis is an extracorporeal process of removing waste products like free water, creatinine and urea, thus maintaining homeostasis in a state of kidney failure.[1]

There are 3 types of dialysis – Slow (or sustained) low efficiency daily dialysis, Continuous renal replacement therapy, Intermittent hemodialysis. The basic principle behind dialysis is diffusion of solutes through a semipermeable membrane. This is achieved by countercurrent flow which helps keep dialysate and blood flowing in opposite direction, thus achieving a gradient across the membrane while attaining maximum efficiency of dialysis. Free water removal is achieved by ultrafiltration, a process of altering the hydrostatic pressure of the dialysate compartment, causing free water and some dissolved solutes to move across the membrane along a created pressure gradient. Dialysate, the main dialysis solution has a sodium and chloride content similar to that of plasma while having slightly higher levels of bicarbonate and glucose to compensate for metabolic acidosis and hypoglycemia respectively. The electrolyte content of the dialysate can be adjusted to compensate for dyselectrolytemia. [2]

Hemodialysis may result in complications such as:

·      Fluid shifts – occurs when fluid is removed too rapidly or large amount of fluid is removed. This leads to common side effects like hypotension, hypertension, cramps, headache, nausea/vomiting, fatigue, chest pain, etc.  These symptoms are commonly refered to as dialysis hangover/washout.

·      First use syndrome – is a rare but severe anaphylactic reaction to the components of dialysis mainly the dialyser filaments or the chemical sterilants used to sterilize it. [3]

·      Dialysis disequilibrium syndrome – a neurological syndrome mostly associated with patients newly initiated on hemodialysis or those who have missed multiple cycles. Caused by reverse urea effect due to rapid removal of urea or intracerebral acidosis. Symptoms include headache, nausea, blurred vision, dizziness, muscle cramps, seizure, somnolence, stupor, or coma which can even lead to death in severe cases.[4]

·      Electrolyte imbalance – Mainly causing imbalance in potassium (hyperkalemia or hypokalemia) and sodium (hyponatremia or hyponatremia) levels. This greatly increases the risk of cardiovascular deaths.[5]

·      Cardiovascular complications – one of the most common complications associated with hemodialysis. Complications include arrhythmias of which diaysis associated complex ventricular arrhythmia is the most common.

There is limited data available on complications of newly initiated dialysis patients especially in Indian population. Through this study we analyse the various complications associated with initiating dialysis, outcomes of patients after initiation, and correlate the clinical profile of these patients with various laboratory investigations.