An overlooked complication of hemodialysis: hoarseness

In hemodialysis patients, some degree of transient hoarseness may occur at the end of the dialysis, and it may be a wearisome, recurrent, and severe state for some hemodialysis patients. However, to date, it has not been a well-defined complication of hemodialysis. The aim of this study was to state this complication and to throw light on it. Four hundred fifty-nine hemodialysis patients were questioned about any change in voice quality during hemodialysis. The patients who had this complaint (n=70) were included in the study, and the group of patients who suffered hoarseness (subgroup 1: severe, subgroup 2: moderate, subgroup 3: mild) were compared with each other and with the control group, which did not suffer hoarseness (n=51). Hoarseness was found in 15.2% of the hemodialysis patients. The duration of their hoarseness was minimum 1 to maximum 24 hours. In the control group, coronary artery disease (P=0.056), congestive heart failure (P=0.049), autonomic neuropathy (P=0.001), severe intradialytic hypotensive attacks (P=0.000), heart valve abnormalities (P=0.000), and left ventricular diastolic dysfunction (P=0.000) were significantly lower than in hoarseness group. Older age (P=0.024), coronary artery disease (P=0.014), autonomic neuropathy (P=0.011), and intradialytic hypotensive attacks (P=0.0001), were associated with severe and moderate hoarseness. In the comparison of % change for systolic and diastolic blood pressure between the hoarseness subgroups, diastolic blood pressure change was not different (P=0.521), but systolic blood pressure change was statistically lower in mild group than moderate (P=0.033) and severe subgroup (P=0.029). Dialysis-induced hypotension may be the main contributor of transient hoarseness. Especially elderly and cardiovascularly compromised patients, who are vulnerable to rapid changes in volume status may experience it to serious extent and this complication may be mediated by autonomic nervous control related with volume depletion.