Dr Samantha Giang1, Dr Mathushan Thevaraja1, Dr Anvesh Chalasani1, Dr Natalie Teh1, Dr Shaundeep Sen1
1Concord Repatriation General Hospital, Concord, Australia
Biography:
Dr Samantha Giang is a Renal Advanced Trainee for the Central-Southwest Network, NSW.
Background:
Complications during intermittent haemodialysis (iHD) are common, leading to impact on patient safety and treatment tolerance. Whilst high ultrafiltration (UF) rates have been linked to haemodynamic instability, other patient-related factors may also contribute to complications.
Aims:
To review incidence of complications during iHD and its associated risk factors.
Methods:
A retrospective audit was conducted of all patients receiving chronic iHD at Concord Hospital during February 2024. Data collected included demographics, co-morbidities, documented complications, UF rates and management.
Results:
Amongst 130 patients across 1560 individual dialysis sessions, 42% (54/130) had at least one documented complication, with 15 patients affected in two sessions, 4 affected in three sessions, 5 affected in four sessions and 2 affected in five sessions. Common complications included intradialytic hypotension, cramping and dizziness. Of the sessions with intradialytic hypotension, the majority resulted in reduction in target UF (44/72), reduced dialysis hours (10/72) or both (12/72). There was no correlation with complications and high UF rates (defined as ≥ 10ml/kg/hr), session following a prolonged inter-dialytic period (defined as ≥ 2 days), age, haemoglobin or weight. Co-morbid hypertension was present in 70% (38/54) of patients with complications compared to 54% (41/76) patients without (p=0.05), and type 2 diabetes in 48% (26/54) of patients with complications vs 27% (21/76) in patients without (p=0.01). Only 17/100 complicated dialysis sessions were escalated to medical reviews.
Conclusion:
iHD-related complications were common particularly in patients with hypertension and diabetes. Recurrent events occur in a subset of patients and low rates of escalation to medical reviews highlight the need for greater risk stratification and proactive clinical review protocols.