INDICATIONS AND COMPLICATIONS IN BRIEF

1. HEMODIALYSIS
INDICATIONS AND
COMPLICATIONS
PRESENTED BY
SHAMBHAVI SHARMA (INTERN)
KIST MEDICAL COLLEGE

2. INTRODUCTION
• is a process of purifying the blood of a person whose
kidneys are not working normally.
• achieves the extracorporeal removal of waste products such
as creatinine and urea and free water from the blood when
the kidneys are in a state of renal failure.

5. INDICATIONS
• EMERGENCY
1. Severe metabolic acidosis
2. Electrolyte disbalance
3. Acute intoxication
4. Features of fluid overload
5. Uremic features: encepthalopathy
pericarditis
gastropathy
Maintainance hemodialysis
1.ESRD

6. APPROACH
• SELECTION OF PATIENT AS INDICATED
ACCESS
1.AV FISTULA
Advantage:
 Low infection rate
 Higher blood flow rate
 Lower chances of stenosis/thrombosis
Disadvantage:
 Longer maturation time
 Aneurysm formation
 Higher chances of subclavian steal syndrome

7. 2.CATHETER:
Advantage:
•Immediate assessment
•Easy to place is veins are patent
Disadvantage
Flow rates are limited
Higher infection rate

8. 3.GRAFTS
Advantage:
• Can be used much sooner
Disadvantage:
• Higher infection rate
• Higher chances of re stenosis/thrombosis
• Steal syndrome
• pseudo aneurysms

9. ASSESSMENT OF PATIENT BEFORE STARTING DIALYSIS
CHECK IF ACCESS IS WORKING
 HAEMOGLOBIN LEVEL
 DRY BODY WEIGHT
 BLOOD PRESSURE
 S.UREA /S.CREATININE
 CHEST X-RAY

10. Post dialysis assessment
• BODY WEIGHT
• CHEST XRAY
• S UREA/S. CREATININE

11. COMPLICATIONS
ACUTE COMPLICATIONS:
1. HYPOTENSION
2. DISEQUILIBRIUM SYNDROME
3. CARDIAC ARRYTHMIA
4. MEMBRANE ASSOCIATED (manifests as back pain, chest pain,
bronchospasm, anaphylaxis)
5. HEPARIN ASSOCIATED(subdural hematoma,
GI,pericardial,retroperitoneal,pleural hemorrhage)

12. MECHANICAL COMPLICATIONS
1.HEMOLYSIS
2. AIR EMBOLUS
3.BLOOD LEAKS
4.CONTAMINATED DIALYSATE ( aluminium contamination leads to dialysis
dementia, osteomalacia)

13. LONG TERM COMPLICATIONS
1.AV FISTULA RELATED: INFECTION (septicemia,septic embolus)
THROMBOSIS
ANEURYSM

14. 2.DEPRESSION
3.MI , CVA (A/w risk factors
HTN,Hyperlipidemia,hyperthyroidism,increased cardiac output d/t
anemia)
4.HIV, HEP B, NON A NON B HEPATITIS, CMV INFECTION

15. THANK YOU