Complications of long-term dialysis

With many people getting diagnosed with kidney failure at a young age and with better survival on dialysis due to better techniques and safety in dialysis machines and centres, more and more people are living for longer on dialysis compared to a few years back.

However, despite better dialysis quality, nothing can come close to a healthy human kidney. That is why, over time, many dialysis patients develop certain complications which can become problematic. Some of them can be prevented. Some can be treated. And yet, there are some about which nothing can be done.

Here are a few of them.

Cardiac problems are one of the most common faced by long term dialysis patients. An adult healthy human heart is capable of pumping about 5-6 litres of blood. Since long term dialysis patients typically pass little or no urine, the excess fluid builds up in the blood between two dialysis sessions. This causes the heart to pump a higher volume of blood than it is capable of pumping. The more the excess fluid, the more the strain on the heart. This causes the heart to enlarge and eventually fail where it is unable to pump efficiently. 

Rapid removal of this excess fluid causes 'myocardial stunning' which is also harmful for the heart.

Most dialysis patients die of heart failure and not directly due to kidney failure. To reduce the extent of this problem, patients can try to increase the number of hours of dialysis per week by either increasing the dialysis frequency or the duration of the session or both.

Bone problems are caused in long-term dialysis patients when there is an imbalance of Calcium, Phosphorus and Parathyroid Hormone. Vitamin D and Alkaline Phosphatase also play a role. This imbalance causes several problems. Bone loss happens because of which there is an increased tendency for fractures. Calciphylaxis is a life-threatening condition where calcification of blood vessels causes lesions under the skin etc. This is thought to be preventable by keeping the product of the Serum Calcium and Serum Phosphorus to less than 55 when both of these parameters are reported in mg/dL.

Neuropathy is a problem that occurs mainly in the feet and hands. This results in numbness and  a condition called restless legs syndrome. While these two problems can be relieved partially with medication, sometimes, the symptoms are so bad that patients don't realise it when they get injured and these injuries can get serious. So those with this condition should have someone examine their feet regularly for any signs of injury.

Dialysis-related Amyloidosis (DRA) is a condition where Beta-2 Microglobulin starts depositing in different parts of the body. These deposits cause a variety of symptoms ranging from pain to numbness and sometimes even more severe symptoms like strokes and cardiac arrests if they are deposited in the brain or the heart. DRA can be prevented to a large extent by doing more efficient dialysis by using a High Flux Dialyser or undergoing Hemodiafiltration. Regular dialysis does not remove Beta-2 Microglobulin and other molecules, causing them to be retained within the body and then start depositing in different parts of the body.

Sexual Dysfunction is fairly common among long-term dialysis patients. Lack of desire in both sexes and erectile dysfunction in males are widely prevalent. There are treatments that work for some people and do not work in others. But it is worth talking to your doctor about the specific problem.

There are a few other problems that are not major but can be bothersome. Thinning of the skin (tendency to get cut easily), hair loss, muscle weakness are some of them. Muscle weakness can be prevented and to some extent treated as well by strength training. Patients should try and incorporate strength training into their daily routine as early as possible.

So, not a pretty picture! But as you can see, many of these problems can be prevented or treated. It is important for us to be aware of the possibility of these conditions and take preventive action where possible. Talking to your doctor in a free and open manner is the key to not suffering needlessly. I have come across many patients who just don't do that. As a result, they have to suffer unnecessarily. So, please develop a relationship with your doctor where you can discuss these things and ask for solutions. They exist, at least most of the time.


Neeraj said…
Thanks for sharing your observations.
Fluid overload is a killer among them all.
I could see many patients are admant not to control the fluid gain between dialysis sessions (IDG) . 3-4kg of gain in 4 hrs of sessions with UF goal needs of 3000 to 4000 ml puts pressure on heart . I read somewhere that per hour rate should not exceed the equation of 10*(dry weight) ml per hour.
Example if dry weight is 50kg then per hour fluid removal rate should be around 10*50 i.e. 500 ml per hour . Anything more than it should be adjusted for longer duration of dialysis such as 5hrs instead of 4hrs.