Ten Long Term Complications of Hemodialysis

Hemodialysis is one of the processes utilized to remove waste products and excess fluids from the blood with the use of a dialyzer (aritificial kidney). This procedure is prescribed to patients diagnosed with chronic kidney disease (CKD) or end-stage renal disease (ESRD) because their damaged kidneys are no longer capable of removing excess toxin and water from the body.

Hemodialysis can extend the life span of an ESRD patient, though this is not without complication. Unfortunately, there are unwanted long term complications brought about by this treatment. Listed below are the ten long term complications of hemodialysis.

1.   Anemia

One of the functions of a kidney is the production of erythropoietin. A person diagnosed with ESRD or CKD has a reduced production of erythropoietin. Erythropoietin is a hormone produced by the kidneys to stimulate the bone marrow to produce red blood cells. The average hemoglobin level of a healthy person is 14-18 gm/dl for adult males and 12-16 gm/dl for adult women.

A person undergoing dialysis has an average hemoglobin level of 7gm/dl without epoeitin injections. Anemia can be further aggravated by the chronic blood loss associated with dialysis procedure and frequent blood sample testing.

2.  Renal Osteodystrophy

Renal osteodystrophy is usually associated with people with kidney disease. In fact this bone disease, affects nearly 90% of patients in dialysis. This occurs when kidneys fail to maintain the proper ratio of calcium and phosphorus in the blood. The most common complaints are sore painful feet, joint and bone pain.

3.  Malnutrition

Malnutrition is common among hemodialysis patients due to the strict nutritional requirements imposed on a patient. Their dietary modification is complex and difficult to adhere to. Nutritional consult is very important to find the balance between nutritional needs of the body. Disease progression of the patient should always be taken into consideration.

4.  Hepatitis

Hepatitis is an indication of an inflamed liver. There are several hepatitis virus strains namely; types A, B, C, D, E, F (not confirmed), and G. Patients who undergo hemodialysis are at greater risk of getting infected with viral hepatitis because of the blood borne organisms that can be transmitted by poor aseptic practices of medical health workers. The risk of getting infected with the virus, fortunately, has gone down due to strict monitoring and safety rules dictated by the Health Department.

5.  Depression

Patients undergoing hemodialysis experience depression one way or another. This psychological disorder is manifested by poor self-image, feeling of guilt, sleep disorder, etc.

6.  Malignant Tumors

According to a study released by the Department of Nephrology in Belgrade, Yugoslavia, hemodialysis patients have greater risks of developing malignant tumors in comparison to the regular population. Author could not find a conclusive study done to support this claim. However, repeated exposure to the chemicals used for reprocessing the dialyzer is a popular theory blamed to increases the risk of acquiring malignant tumors. Among the chemicals used are peracetic acid, formalin, citric acid, etc.

7.  Dialysis Encephalopathy

Dialysis Encelopathy is also known as dialysis dementia. The main culprit for this complication is the accumulation of aluminum accumulation and inadequately treated water used in preparing dialysate.

8.  Carpal Tunnel Syndrome

Carpal Tunnel Syndrome, especially on the arm with the fistula occurs to some chronic hemodialysis patient due to an increase amyloid deposit. To reduce the progression of this disease, high flux or high clearance dialyzer with ultrapure dialysate is recommended.

9.  Cardiovascular Disease

Cardiovascular Disease increases the mortality rate of hemodialysis patients. When a patient has a diseased kidney, regulation of waste products is severely affected. Uremia happens when waste product like urea accumulates in the blood. To quote a phrase in the study Hypertriglyceridemia in Patients with Chronic Renal Failure: Possible Mechanisms "--prominent features of uremic Dyslipedemia are an increase in plasma triglycerides and cholesterol in nearly all lipoproteins, and a reduction in high-density lipoprotein (HDL) cholesterol. Because of its direct contact with the circulating blood, the endothelium is preferentially subjected to the modulatory effects of these altered lipoproteins.”

10.  Uremic Neuropathy

As renal failure progresses, deterioration of nerve function may also be noted. Among the common signs and symptoms observed are loss of sensation, loss of reflexes, and painful burning sensation of the feet. Uremic Neuropathy can be confirmed by nerve conduction study.

Sources:

1. http://www.medicinenet.com/osteodystrophy/article.html

2. http://www.ncbi.nlm.nih.gov/pubmed/8856278

3. http://www.nature.com/ki/journal/v63/n84s/full/4493785a.html

4. Dialysis Training Course. Aesculap Academy Facility B. Braun Avitum Dialysis Center.