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Hemodialysis: Initiation and Complications

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Clinical Decisions in Nephrology, Hypertension and Kidney Transplantation

Abstract

A 60-year-old man with Stage V chronic kidney disease due to biopsy-proven diabetic and hypertensive nephropathy presents to clinic for a routine visit. His estimated glomerular filtration rate is 10 ml/min/1.73 m2 and his blood pressure is 145/80 mmHg. Laboratory studies demonstrate potassium 4.9 mEq/L, total CO2 19 mEq/L, phosphorus 5.0 mg/dL, and hemoglobin 10.5 g/dL. He feels well without weight loss, anorexia, or nausea. He is reluctant to have an arteriovenous fistula placed, and he does not wish to initiate hemodialysis. The patient desires to know the optimal time to initiate dialysis. If he requires dialysis initiation through a tunneled dialysis catheter, what measures can be taken to reduce his risk for catheter infection?

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References

  1. Centers for Disease Control and Prevention (CDC). Hospitalization discharge diagnoses for kidney disease-United States, 1980–2005. MMWR Morb Mortal Wkly Rep. 2005;57:309–12.

    Google Scholar 

  2. Waikar SS, Curhan GC, Wald R, McCarthy EP, Chertow GM. Declining mortality in patients with acute renal failure, 1988 to 2002. J Am Soc Nephrol. 2006;17(4):1143–50.

    Article  PubMed  Google Scholar 

  3. Hsu CY, McCulloch CE, Fan D, Ordonez JD, Chertow GM, Go AS. Community-based incidence of acute renal failure. Kidney Int. 2007;72(2):208–12.

    Article  PubMed  Google Scholar 

  4. Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Ronco C, Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Investigators. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;294(7):813–8.

    Article  PubMed  CAS  Google Scholar 

  5. U.S. Renal Data System. USRDS 2010 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2010.

    Google Scholar 

  6. The Frequent Hemodialysis Network (FHN) Trial Group, Rocco MV, Lockridge Jr RS, Beck GJ, Eggers PW, Gassman JJ, Greene T, Larive B, Chan CT, Chertow GM, Copland M, Hoy CD, Lindsay RM, Levin NW, Ornt DB, Pierratos A, Pipkin MF, Rajagopalan S, Stokes JB, Unruh ML, Star RA, Kliger AS, Kliger A, Eggers P, Briggs J, Hostetter T, Narva A, Star R, Augustine B, Mohr P, Beck G, Fu Z, Gassman J, Greene T, Daugirdas J, Hunsicker L, Larive B, Li M, Mackrell J, Wiggins K, Sherer S, Weiss B, Rajagopalan S, Sanz J, Dellagrottaglie S, Kariisa M, Tran T, West J, Unruh M, Keene R, Schlarb J, Chan C, McGrath-Chong M, Frome R, Higgins H, Ke S, Mandaci O, Owens C, Snell C, Eknoyan G, Appel L, Cheung A, Derse A, Kramer C, Geller N, Grimm R, Henderson L, Prichard S, Roecker E, Rocco M, Miller B, Riley J, Schuessler R, Lockridge R, Pipkin M, Peterson C, Hoy C, Fensterer A, Steigerwald D, Stokes J, Somers D, Hilkin A, Lilli K, Wallace W, Franzwa B, Waterman E, Chan C, McGrath-Chong M, Copland M, Levin A, Sioson L, Cabezon E, Kwan S, Roger D, Lindsay R, Suri R, Champagne J, Bullas R, Garg A, Mazzorato A, Spanner E, Rocco M, Burkart J, Moossavi S, Mauck V, Kaufman T, Pierratos A, Chan W, Regozo K, Kwok S. The effects of frequent nocturnal home hemodialysis: the Frequent Hemodialysis Network Nocturnal Trial. Kidney Int. 2011;80(10):1080–91.

    Article  PubMed  Google Scholar 

  7. Kim JC, Ronco C. Current technological approaches for a wearable artificial kidney. Contrib Nephrol. 2011;171:231–6.

    Article  PubMed  Google Scholar 

  8. Vilar E, Wellsted D, Chandna SM, Greenwood RN, Farrington K. Residual renal function improves outcome in incremental haemodialysis despite reduced dialysis dose. Nephrol Dial Transplant. 2009;24(8):2502–10.

    Article  PubMed  Google Scholar 

  9. Kraut JA, Kurtz I. Use of base in the treatment of acute severe organic acidosis by nephrologists and critical care physicians: results of an online survey. Clin Exp Nephrol. 2006;10(2):111–7.

    Article  PubMed  Google Scholar 

  10. Graf H, Leach W, Arieff AI. Evidence for a detrimental effect of bicarbonate therapy in hypoxic lactic acidosis. Science. 1985;227(4688):754–6.

    Article  PubMed  CAS  Google Scholar 

  11. Sabatini S, Kurtzman NA. Bicarbonate therapy in severe metabolic acidosis. J Am Soc Nephrol. 2009;20(4):692–5.

    Article  PubMed  CAS  Google Scholar 

  12. Aschner JL, Poland RL. Sodium bicarbonate: basically useless therapy. Pediatrics. 2008;122(4):831–5.

    Article  PubMed  Google Scholar 

  13. Capdevila M, Ruiz IM, Ferrer C, Monllor F, Ludjvick C, Garcia NH, Juncos LI. The efficiency of potassium removal during bicarbonate hemodialysis. Hemodial Int. 2005;9(3):296–302.

    Article  PubMed  CAS  Google Scholar 

  14. Heguilen RM, Sciurano C, Bellusci AD, Fried P, Mittelman G, Rosa Diez G, Bernasconi AR. The faster potassium-lowering effect of high dialysate bicarbonate concentrations in chronic haemodialysis patients. Nephrol Dial Transplant. 2005;20(3):591–7.

    Article  PubMed  CAS  Google Scholar 

  15. Nissenson AR, Fine RN, editors. Clinical dialysis. 4th ed. USA: McGraw-Hill Companies, Inc.; 2005.

    Google Scholar 

  16. Mann H, Stiller S. Sodium modeling. Kidney Int Suppl. 2000;76:S79–88.

    Article  PubMed  CAS  Google Scholar 

  17. Koo WS, Jeon DS, Ahn SJ, Kim YS, Yoon YS, Bang BK. Calcium-free hemodialysis for the management of hypercalcemia. Nephron. 1996;72(3):424–8.

    Article  PubMed  CAS  Google Scholar 

  18. Bronstein AC, Spyker DA, Cantilena Jr LR, Green JL, Rumack BH, Giffin SL. 2009 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 27th Annual Report. Clin Toxicol (Phila). 2010;48(10):979–1178.

    Article  Google Scholar 

  19. Bayliss G. Dialysis in the poisoned patient. Hemodial Int. 2010;14(2):158–67.

    Article  PubMed  Google Scholar 

  20. Meertens JH, Jagernath DR, Eleveld DJ, Zijlstra JG, Franssen CF. Haemodialysis followed by continuous veno-venous haemodiafiltration in lithium intoxication; a model and a case. Eur J Intern Med. 2009;20(3):e70–3.

    Article  PubMed  CAS  Google Scholar 

  21. Bismuth C, Conso F, Wattel F, Gosselin B, Lambert H, Genestal M. Coated activated charcoal hemoperfusion: experience of French anti-poison centers about 60 cases. Vet Hum Toxicol. 1979;21(Suppl):2–4.

    PubMed  Google Scholar 

  22. Costanzo MR, Guglin ME, Saltzberg MT, Jessup ML, Bart BA, Teerlink JR, Jaski BE, Fang JC, Feller ED, Haas GJ, Anderson AS, Schollmeyer MP, Sobotka PA, UNLOAD Trial Investigators. Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure. J Am Coll Cardiol. 2007;49(6):675–83.

    Article  PubMed  CAS  Google Scholar 

  23. Pockros PJ, Reynolds TB. Rapid diuresis in patients with ascites from chronic liver disease: the importance of peripheral edema. Gastroenterology. 1986;90(6):1827–33.

    PubMed  CAS  Google Scholar 

  24. Alpert MA, Ravenscraft MD. Pericardial involvement in end-stage renal disease. Am J Med Sci. 2003;325(4):228–36.

    Article  PubMed  Google Scholar 

  25. Tseng JR, Lee MJ, Yen KC, Weng CH, Liang CC, Wang IK, Chang CT, Lin-Tan DT, Lin JL, Yen TH. Course and outcome of dialysis pericarditis in diabetic patients treated with maintenance hemodialysis. Kidney Blood Press Res. 2009;32(1):17–23.

    Article  PubMed  Google Scholar 

  26. Rosansky SJ, Eggers P, Jackson K, Glassock R, Clark WF. Early start of hemodialysis may be harmful. Arch Intern Med. 2011;171(5):396–403.

    Article  PubMed  Google Scholar 

  27. Hwang SJ, Yang WC, Lin MY, Mau LW, Chen HC, Taiwan Society of Nephrology. Impact of the clinical conditions at dialysis initiation on mortality in incident haemodialysis patients: a national cohort study in Taiwan. Nephrol Dial Transplant. 2010;25(8):2616–24.

    Article  PubMed  Google Scholar 

  28. Evans M, Tettamanti G, Nyren O, Bellocco R, Fored CM, Elinder CG. No survival benefit from early-start dialysis in a population-based, inception cohort study of Swedish patients with chronic kidney disease. J Intern Med. 2011;269(3):289–98.

    Article  PubMed  CAS  Google Scholar 

  29. Harris A, Cooper BA, Jing J, Bulfone L, Branley P, Collins JF, Craig JC, Fraenkel MB, Johnson DW, Kesselhut J, Luxton G, Pilmore A, Rosevear M, Tiller DJ, Pollock CA, Harris DC. Cost-effectiveness of initiating dialysis early: a randomized controlled trial. Am J Kidney Dis. 2011;57(5):707–15.

    Article  PubMed  Google Scholar 

  30. Bouman CS, Oudemans-Van Straaten HM, Tijssen JG, Zandstra DF, Kesecioglu J. Effects of early high-volume continuous venovenous hemofiltration on survival and recovery of renal function in intensive care patients with acute renal failure: a prospective, randomized trial. Crit Care Med. 2002;30(10):2205–11.

    Article  PubMed  Google Scholar 

  31. Liu KD, Himmelfarb J, Paganini E, Ikizler TA, Soroko SH, Mehta RL, Chertow GM. Timing of initiation of dialysis in critically ill patients with acute kidney injury. Clin J Am Soc Nephrol. 2006;1(5):915–9.

    Article  PubMed  CAS  Google Scholar 

  32. Bouchard J, Soroko SB, Chertow GM, Himmelfarb J, Ikizler TA, Paganini EP, Mehta RL, Program to Improve Care in Acute Renal Disease (PICARD) Study Group. Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury. Kidney Int. 2009;76(4):422–7.

    Article  PubMed  Google Scholar 

  33. Payen D, de Pont AC, Sakr Y, Spies C, Reinhart K, Vincent JL, Sepsis Occurrence in Acutely Ill Patients (SOAP) Investigators. A positive fluid balance is associated with a worse outcome in patients with acute renal failure. Crit Care. 2008;12(3):R74.

    Article  PubMed  Google Scholar 

  34. Ronco C, Bellomo R, Homel P, Brendolan A, Dan M, Piccinni P, La Greca G. Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial. Lancet. 2000;356(9223):26–30.

    Article  PubMed  CAS  Google Scholar 

  35. Schiffl H, Lang SM, Fischer R. Daily hemodialysis and the outcome of acute renal failure. N Engl J Med. 2002;346(5):305–10.

    Article  PubMed  Google Scholar 

  36. VA/NIH Acute Renal Failure Trial Network, Palevsky PM, Zhang JH, O’Connor TZ, Chertow GM, Crowley ST, Choudhury D, Finkel K, Kellum JA, Paganini E, Schein RM, Smith MW, Swanson KM, Thompson BT, Vijayan A, Watnick S, Star RA, Peduzzi P. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med. 2008;359(1):7–20.

    Article  PubMed  CAS  Google Scholar 

  37. Tolwani AJ, Campbell RC, Stofan BS, Lai KR, Oster RA, Wille KM. Standard versus high-dose CVVHDF for ICU-related acute renal failure. J Am Soc Nephrol. 2008;19(6):1233–8.

    Article  PubMed  Google Scholar 

  38. RENAL Replacement Therapy Study Investigators, Bellomo R, Cass A, Cole L, Finfer S, Gallagher M, Lo S, McArthur C, McGuinness S, Myburgh J, Norton R, Scheinkestel C, Su S. Intensity of continuous renal-replacement therapy in critically ill patients. N Engl J Med. 2009;361(17):1627–38.

    Article  PubMed  Google Scholar 

  39. Hemodialysis (HEMO) Study Group, Eknoyan G, Beck GJ, Cheung AK, Daugirdas JT, Greene T, Kusek JW, Allon M, Bailey J, Delmez JA, Depner TA, Dwyer JT, Levey AS, Levin NW, Milford E, Ornt DB, Rocco MV, Schulman G, Schwab SJ, Teehan BP, Toto R. Effect of dialysis dose and membrane flux in maintenance hemodialysis. N Engl J Med. 2002;347(25):2010–9.

    Article  PubMed  Google Scholar 

  40. Depner T, Daugirdas J, Greene T, Allon M, Beck G, Chumlea C, Delmez J, Gotch F, Kusek J, Levin N, Macon E, Milford E, Owen W, Star R, Toto R, Eknoyan G, Hemodialysis Study Group. Dialysis dose and the effect of gender and body size on outcome in the HEMO Study. Kidney Int. 2004;65(4):1386–94.

    Article  PubMed  Google Scholar 

  41. Port FK, Wolfe RA, Hulbert-Shearon TE, McCullough KP, Ashby VB, Held PJ. High dialysis dose is associated with lower mortality among women but not among men. Am J Kidney Dis. 2004;43(6):1014–23.

    Article  PubMed  Google Scholar 

  42. Hemodialysis Adequacy 2006 Work Group. Clinical practice guidelines for hemodialysis adequacy, update 2006. Am J Kidney Dis. 2006;48 Suppl 1:S2–90.

    Google Scholar 

  43. Caplin B, Kumar S, Davenport A. Patients’ perspective of haemodialysis-associated symptoms. Nephrol Dial Transplant. 2011;26(8):2656–63.

    Article  PubMed  Google Scholar 

  44. Arieff AI. Dialysis disequilibrium syndrome: current concepts on pathogenesis and prevention. Kidney Int. 1994;45(3):629–35.

    Article  PubMed  CAS  Google Scholar 

  45. Silver SM, Sterns RH, Halperin ML. Brain swelling after dialysis: old urea or new osmoles? Am J Kidney Dis. 1996;28(1):1–13.

    Article  PubMed  CAS  Google Scholar 

  46. Lasocki S, Piednoir P, Ajzenberg N, Geffroy A, Benbara A, Montravers P. Anti-PF4/heparin antibodies associated with repeated hemofiltration-filter clotting: a retrospective study. Crit Care. 2008;12(3):R84.

    Article  PubMed  Google Scholar 

  47. Centers for Disease Control and Prevention (CDC). Vital signs: central line—associated blood stream infections—United States, 2001, 2008, and 2009. MMWR Morb Mortal Wkly Rep. 2011;60(8):243-–248.

    Google Scholar 

  48. Ng LJ, Chen F, Pisoni RL, Krishnan M, Mapes D, Keen M, Bradbury BD. Hospitalization risks related to vascular access type among incident US hemodialysis patients. Nephrol Dial Transplant. 2011;26(11):3659–66.

    Article  PubMed  Google Scholar 

  49. Betjes MG. Medscape. Prevention of catheter-related bloodstream infection in patients on hemodialysis. Nat Rev Nephrol. 2011;7(5):257–65.

    Article  PubMed  CAS  Google Scholar 

  50. Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O’Grady NP, Raad II, Rijnders BJ, Sherertz RJ, Warren DK. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;49(1):1–45.

    Article  PubMed  CAS  Google Scholar 

  51. Dheenan S, Henrich WL. Preventing dialysis hypotension: a comparison of usual protective maneuvers. Kidney Int. 2001;59(3):1175–81.

    Article  PubMed  CAS  Google Scholar 

  52. Selby NM, McIntyre CW. A systematic review of the clinical effects of reducing dialysate fluid temperature. Nephrol Dial Transplant. 2006;21(7):1883–98.

    Article  PubMed  Google Scholar 

  53. Prakash S, Garg AX, Heidenheim AP, House AA. Midodrine appears to be safe and effective for dialysis-induced hypotension: a systematic review. Nephrol Dial Transplant. 2004;19(10):2553–8.

    Article  PubMed  CAS  Google Scholar 

  54. Mathur VS, Lindberg J, Germain M, Block G, Tumlin J, Smith M, Grewal M, McGuire D, ITCH National Registry Investigators. A longitudinal study of uremic pruritus in hemodialysis patients. Clin J Am Soc Nephrol. 2010;5(8):1410–9.

    Article  PubMed  Google Scholar 

  55. Kuypers DR. Skin problems in chronic kidney disease. Nat Clin Pract Nephrol. 2009;5(3):157–70.

    Article  PubMed  Google Scholar 

  56. Balaskas E, Szepietowski JC, Bessis D, Ioannides D, Ponticelli C, Ghienne C, Taberly A, Dupuy P. Randomized, double-blind study with glycerol and paraffin in uremic xerosis. Clin J Am Soc Nephrol. 2011;6(4):748–52.

    Article  PubMed  CAS  Google Scholar 

  57. Gunal AI, Ozalp G, Yoldas TK, Gunal SY, Kirciman E, Celiker H. Gabapentin therapy for pruritus in haemodialysis patients: a randomized, placebo-controlled, double-blind trial. Nephrol Dial Transplant. 2004;19(12):3137–9.

    Article  PubMed  CAS  Google Scholar 

  58. Kavanagh D, Siddiqui S, Geddes CC. Restless legs syndrome in patients on dialysis. Am J Kidney Dis. 2004;43(5):763–71.

    Article  PubMed  Google Scholar 

  59. de Oliveira MM, Conti CF, Valbuza JS, de Carvalho LB, do Prado GF. The pharmacological treatment for uremic restless legs syndrome: evidence-based review. Mov Disord. 2010;25(10):1335–42.

    Article  PubMed  Google Scholar 

  60. Jaber BL, Schiller B, Burkart JM, Daoui R, Kraus MA, Lee Y, Miller BW, Teitelbaum I, Williams AW, Finkelstein FO, FREEDOM Study Group. Impact of short daily hemodialysis on restless legs symptoms and sleep disturbances. Clin J Am Soc Nephrol. 2011;6(5):1049–56.

    Article  PubMed  Google Scholar 

  61. Granado RC, Macedo E, Chertow GM, Soroko S, Himmelfarb J, Ikizler TA, Paganini EP, Mehta RL. Effluent volume in continuous renal replacement therapy overestimates the delivered dose of dialysis. Clin J Am Soc Nephrol. 2011;6(3):467–75.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, 1830 East Monument Street, Room 416, Baltimore, MD, 21205, USA

    C. John Sperati M.D., M.H.S.

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Correspondence to C. John Sperati M.D., M.H.S. .

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  1. Chicago College of Medicine, Nephrology, University of Illinois, Wisconsin Avenue 3543, Berwyn, 60402, Illinois, USA

    Edgar V. Lerma

  2. , Division of Nephrology, University of Virginia Health System, Box 800133, Charlottesville, 22908, Virginia, USA

    Mitchell Rosner

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Sperati, C.J. (2013). Hemodialysis: Initiation and Complications. In: Lerma, E., Rosner, M. (eds) Clinical Decisions in Nephrology, Hypertension and Kidney Transplantation. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-4454-1_31

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