RESUMEN
Dialysis reactions are not uncommon in End Stage Renal Disease (ESRD) patients who are undergoing in-center hemodialysis. Here we report the first case of anaphylaxis related to citric acid solutions used for dialysis machine disinfection and descaling. The patient developed repeated episodes of anaphylactic reactions during hemodialysis only in the inpatient setting leading to respiratory failure needing intubation and anaphylactic shock. This had failed to resolve despite using various combinations of different dialysis machines and dialyzer membranes and only resolved after the elimination of citric acid from the dialysis circuit. This case highlights the importance of different allergens in dialysis circuits and emphasizes the importance of looking for alternative reasons for dialyzer reactions.
Asunto(s)
Anafilaxia , Fallo Renal Crónico , Humanos , Diálisis Renal , Anafilaxia/inducido químicamente , Anafilaxia/diagnóstico , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/terapia , Ácido CítricoRESUMEN
Since maintenance hemodialysis (HD) first became available in the United States in 1962, there has been tremendous growth in the population of patients with kidney failure. HD has become a routine treatment carried out in outpatient clinics, hospitals, nursing facilities, and in patients' homes. Although it is a complex procedure, HD is quite safe. Serious complications are uncommon due to the use of modern HD machines and water treatment systems as well as the development of strict protocols to monitor various aspects of the HD treatment. The practicing nephrologist must be knowledgeable about life-threatening complications that can occur during HD and be able to recognize, manage, and prevent them. This installment in the AJKD Core Curriculum in Nephrology reviews the pathogenesis, management, and prevention of 9 HD emergencies. The HD emergencies covered include dialyzer reactions, dialysis disequilibrium syndrome, uremic/dialysis-associated pericarditis, air embolism, venous needle dislodgement, vascular access hemorrhage, hemolysis, dialysis water contamination, and arrhythmia episodes.
Asunto(s)
Urgencias Médicas , Fallo Renal Crónico/terapia , Diálisis Renal/efectos adversos , Arritmias Cardíacas/etiología , Arritmias Cardíacas/fisiopatología , Arritmias Cardíacas/terapia , Edema Encefálico , Descontaminación , Soluciones para Diálisis/normas , Embolia Aérea/etiología , Embolia Aérea/fisiopatología , Embolia Aérea/terapia , Transferencias de Fluidos Corporales , Hemólisis , Hemorragia/etiología , Hemorragia/fisiopatología , Hemorragia/terapia , Humanos , Hipersensibilidad/etiología , Hipersensibilidad/fisiopatología , Hipersensibilidad/terapia , Riñones Artificiales/efectos adversos , Agujas , Nefrología , Pericarditis/etiología , Pericarditis/fisiopatología , Pericarditis/terapia , Falla de Prótesis , Esterilización , Uremia/complicaciones , Purificación del Agua/normasRESUMEN
Introduction Hemodialysis is a vital management option for end-stage renal disease (ESRD) patients. With adequate hemodialysis, patients can have a good quality of life but complications do occur during the session, which can be minor to life-threatening. The objective of this study was to assess the frequency of acute complications during this procedure. Material and methods An observational, cross-sectional study was conducted at Jinnah Postgraduate Medical Centre, Karachi, Pakistan. Patient data were collected about access, comorbid conditions, frequency and duration of hemodialysis, and intradialytic complications. Those with acute kidney injury were excluded. Results There was a total of 94 patients, with a mean age of 45.51±13.29 years, of which 62 (66%) were males and 32 (34%) were females. Diabetes mellitus was the most common cause of ESRD (47.9%, n=45). Patients on twice and thrice-weekly sessions were 51 (54.3%) and 43 (45.7%), respectively. The most common complication was hypotension (28.7%), followed by hypertension (17%), and nausea/vomiting (11.7%). The arteriovenous fistula was the most common access used (75.5%, n=71). Most patients were found to be on hemodialysis for more than five years (51.1%, n=48). Conclusion Blood pressure changes are critical while performing hemodialysis, just like we found hypotension as the most common intradialytic complication in our results, followed by hypertension. Others were fever, muscle cramps, and nausea/vomiting. a prospective follow-up study shall be done to have comparative and long-term results related to the acute and chronic complications of dialysis.
RESUMEN
Dialyzer reactions are long-appreciated complications of dialysis. Despite advances in dialysis machines and membranes, these life-threatening reactions still occur. It is imperative to recognize potential dialyzer reactions when assessing adverse dialysis events as reexposure to dialytic treatments could be life threatening. We present the case of a 72-year old woman with dialysis-requiring anuric acute kidney injury who experienced acute hypotension and cardiopulmonary arrest during both continuous renal replacement therapy and a subsequent hemodialysis treatment. We concluded that she had an anaphylactic reaction to an unidentified component of the dialysis equipment. Identification, work up, treatment, and reporting of dialyzer reactions are discussed in the context of this case.