Dialysis Emergencies

Dialysis patients are susceptible to dialysis disequilibrium syndrome which can present as altered mental status, focal neurological deficits or even frank coma or seizures after dialysis. Make sure to consider a broad differential in these patients and start with a solute load such as an amp or two of D50 while starting your work up.

 How to stop a post-dialysis site bleeding

Expecting gauze, even Combat gauze, to stop bleeding without a significant amount of direct pressure is magical thinking.

 The Dialysis Patient: Managing Fistula Complications in the Emergency Department

Pseudoaneurysms are pulsating extravascular hematomas resulting from dialysis site access. These are rare complications of AV fistula access.7,10 As compared to aneurysms, patients with pseudoaneurysms are more likely to present to the emergency department for vascular hemorrhage or signs and symptoms consistent with infection.

Chronic Kidney Disease and Dialysis-Related Emergencies

Although patients with acute kidney injury (AKI) have a relatively rapid loss of renal function and tend to develop clinical manifestations requiring prompt attention, patients with chronic renal disease have usually experienced a slow decrease in renal function over a period of months to years.

Dialysis Access Emergencies

Thrombosis represents a common complication contributing to frequent hospitalizations of dialysis-dependent patients.

Dialysis Complications

Dialysis complications may be: Vascular access related (infection, bleeding), Nonvascular access related (hypotension, hyperkalemia), Peritoneal dialysis (PD) related.

Dialysis-Related Emergencies

Infection is a common cause of morbidity and mortality in dialysis patients. Tunneled lines and temporary dialysis catheters are more likely to become infected than grafts and native arteriovenous fistulas.

ED Repair of Bleeding Dialysis Shunt

Video by Alfred Sacchetti.

Emergencies in Renal Failure and Dialysis Patients

Patients with end-stage renal disease (ESRD) may sustain multiple complications of their disease process and treatment. Emergent dialysis is most commonly required for hyperkalemia, severe metabolic acidosis, and pulmonary edema resistant to alternative therapy.

End-Stage Renal Failure

End-stage renal failure has multiple implications for ICU management...

Episode 26: End Stage Renal Disease Complications

End stage renal disease (ESRD) very common, defined by glomerular filtration rate (GFR) less than 15 mL/min. Patients most commonly die from cardiovascular disease, and sepsis is the most common cause of hospitalization.

Fluid Administration in End-Stage Renal Disease for Severe Sepsis and Septic Shock

In patients who have end-stage renal disease and severe sepsis or septic shock, we can give the 30mL/kg fluid bolus recommended by the SSC guidelines within the first 6 hours of resuscitation. Based on these two retrospective studies, administration of this fluid bolus does not seem to be associated with worse outcomes such as increased intubation, need for urgent dialysis, or hospital mortality. However, use careful assessments of your patient’s physiology to determine whether they require more fluids. Further prospective research is needed to determine whether fluid bolus administration causes harm or not.

Sepsis in end-stage renal disease patients: are they at an increased risk of mortality?

ESRD patients admitted to the intensive care unit with sepsis are at greater odds of mortality compared to patients with non-ESRD. This risk is particularly increased if these patients have a concomitant history of chronic cardiac and respiratory illnesses.

The Sick ESRD Patient

This does not discuss all of the conditions that may result in the specific patient presentations. Keep your differential broad!