genitourinary disorders
Hemodialysis
Dialysis complications
Complications are listed in table Complications of Renal Replacement Therapy . Themost common complication of dialysisis Hypotension Hypotension has multiple causes, including too-rapid water removal, osmotic fluid shifts across cell membranes, acetate in the dialysate, heat-related vasodilation, allergic reactions, sepsis, and underlying conditions (eg, autonomic neuropathy, cardiomyopathy with poor ejection fraction, myocardial ischemia, arrhythmias). Other frequent complicationsinclude Periodic Limb Movement Disorder (PLMD) and Restless Legs Syndrome (RLS) None Cramps Pruritus Nausea and vomiting Headache Chest and back pain In most cases, these complications occur for unknown reasons, but some may be part of a first-use syndrome (when the patient’s blood is exposed to cuprophane or cellulose membranes in the dialyzer) or dialysis dysequilibrium syndrome, a syndrome thought to be caused by too-rapid removal ofureaand other osmolytes from the serum, causing osmotic movement of fluid into the brain. More severe cases of dialysis dysequilibrium manifest as disorientation, restlessness, blurred vision, confusion, seizures, and even death. Dialysis-related amyloidosisaffects patients who have been on hemodialysis for years and manifests as carpal tunnel syndrome, bone cysts, arthritis, and cervical spondyloarthropathy. Dialysis-related amyloidosis is believed to be less common with the high-flux dialyzers in wide use today because beta-2 microglobulin (the protein causing the amyloidosis) is removed more effectively with these dialyzers. 