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Hospitalization for initiation of maintenance hemodialysis
Mahendra Agraharkar1, Mario A Martinez, Yong-Fang Kuo
1Department of Medicine, Division of Nephrology, University of Texas Medical Branch, Galveston, Tex, USA. mlagraha@utmb.edu
Nephron. Clinical Practice
|July 3, 2004
Summary
Hospitalization for initiating hemodialysis (HD) is not necessary. Older patients with anemia face higher risks of mild complications like hypotension and cramps during HD initiation.
Area of Science:
- Nephrology
- Internal Medicine
- Critical Care Medicine
Background:
- Limited recent data exists on complications during hemodialysis (HD) initiation.
- Despite technological advancements, hospitalization for initiating maintenance HD is common for end-stage renal disease (ESRD) patients.
- This study assesses the justification for such admissions and identifies HD initiation complication predictors.
Purpose of the Study:
- To determine the incidence and predictors of complications during the initiation of maintenance hemodialysis.
- To evaluate whether hospitalization solely for initiating hemodialysis is justified.
Main Methods:
- Retrospective review of adult patients initiated on maintenance hemodialysis between January 1998 and December 2000.
- Data collected included demographics, cause of renal failure, vascular access, comorbidities, serum chemistries, and intradialytic complications.
- Complications were retrieved from dialysis flow sheets.
Main Results:
- 18.3% of patients experienced complications during HD initiation; none were severe.
- Hypotension and leg cramps were the most frequent complications.
- Older age (p=0.02) and lower hematocrit (HCT) were significant predictors of complications. Older anemic patients had a higher risk.
Conclusions:
- Hypotension and muscle cramps are the primary complications during HD initiation, predominantly affecting older anemic patients.
- These complications rarely require physician intervention.
- Hospitalization solely for initiating maintenance dialysis is not justified due to associated costs and low complication rates.