What Are the Complications Associated with Hemodialysis

What Are the Complications Associated with Hemodialysis?

• Hypotension. About 40% of patients experienced low blood pressure, or hypotension, during hemodialysis, which can be attributed to several possible factors, including hypovolemia and the overproduction of nitric oxide. Nitric oxide is the strongest vasodilator produced in the body. Extracorporeal circulation activates a nitric oxide–producing enzyme in red blood cells to produce too much nitric oxide, causing hypotension during hemodialysis. Symptoms of hypotension during hemodialysis include shortness of breath, abdominal pain, and muscle spasms.

• Anemia. Anemia is common in hemodialysis patients. Kidney failure patients are unable to produce erythropoietin, a protein that supports the synthesis of new red blood cells in the bone marrow, leading to anemia. Improper diet as well as the loss of iron and vitamins during hemodialysis can exacerbate the symptoms of anemia in hemodialysis patients.

• Bone disease. One important function of the kidneys is to convert vitamin D from its inactive form to its active form. Patients in hemodialysis are unable to produce the active form of vitamin D. Vitamin D deficiency leads to a multitude of health problems, including bone diseases such as osteomalacia and osteoporosis, both of which are prevalent in hemodialysis patients.

• Hypertension. Hypertension is common in hemodialysis patients. As mentioned above, about 40% of hemodialysis patients develop hypotensive episodes during hemodialysis. A bolus injection of saline solution is an effective way of expanding the blood volume and restoring blood pressure. However, excessive water from this saline solution cannot be removed by the kidneys in hemodialysis patients. Accumulation of excessive water in the blood exerts the pressure on the arterial wall and brings on hypertension. Hemodialysis patients who require bolus injections of saline solution have a greater risk of hypertension.

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