A In the United States, more than 450,000 patients are on dialysis due to end-stage renal disease. Compared to the general population, these patients account for a disproportionate number of emergency department visits due to higher rates of infection and cardiovascular complications, as well as issues unique to the process of dialysis itself, such as vascular access problems and dialysis disequilibrium syndrome.
Our recent issue Emergency Department Management of Patients With Complications of Dialysis describes the pathophysiology arising from hemodialysis and peritoneal dialysis-related complications, as well as the evaluation and initial treatment within the emergency department, based on best available evidence.
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Here are a few key points:
- Complications of hemodialysis include hypotension (most common), dialysis disequilibrium, air embolism, hemolysis (from chloramine in the water supply of hemodialysis centers), venous needle dislodgement, and allergic reactions to dialysate or medications.
- Patients with central venous catheters (CVCs) are at highest risk for bacteremia.15-18
- Central venous stenosis (see Figure 4) may occur in 40%-50% of patients with a CVC, causing arm swelling, pain, varicose vein in the chest and neck, superior vena cava syndrome, and skin breakdown.
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