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(A)typical symptoms during single needle dialysis
R O Hombrouckx1, J Y De Vos, L A Larno
1Dialysis Unit, Kliniek Hogerlucht, Ronse, Belgium.
ASAIO Transactions
|July 1, 1990
Summary
Dialysis using fistula catheters caused severe symptoms like angina and hypotension due to red cell fragmentation. Switching to central catheters significantly reduced these adverse events, highlighting the need for improved fistula catheter design.
Area of Science:
- Nephrology
- Hematology
- Medical Devices
Background:
- Elderly patients undergoing dialysis experienced unusual symptoms including angina, persistent hypotension, and esophageal spasms.
- These symptoms occurred despite using biocompatible membranes and bicarbonate dialysate with a single-needle fistula catheter system.
Purpose of the Study:
- To investigate the cause of dialysis-related symptoms and evaluate the effectiveness of switching dialysis access methods.
Main Methods:
- Five elderly patients experiencing adverse symptoms during dialysis were studied.
- Patients were switched from fistula dialysis (A) to central catheter dialysis (B) while maintaining similar dialysis parameters.
- Biochemical markers (LDH, haptoglobin) and clinical event frequencies were compared between the two methods.
Main Results:
- Fistula dialysis (A) was associated with significant red cell fragmentation (RCF), indicated by elevated LDH ratios (1.8) and decreased haptoglobin.
- Central catheter dialysis (B) showed no RCF (LDH ratio 1.0) and a dramatic reduction in adverse events: angina (26% vs 3%), hypotension (7% vs 0.6%), and esophageal spasms (13% vs 0%).
Conclusions:
- Red cell fragmentation caused by peripheral dialysis catheters is a likely cause of severe dialysis-related symptoms.
- Central catheter dialysis offers a safer alternative, significantly improving patient outcomes.
- There is a critical need for improved design and manufacturing of peripheral dialysis catheters.