Complications of haemodialysis

Haemodialysis is an essential treatment for patients with severe or end-stage kidney failure. Despite advances in dialysis techniques, it may be associated with acute or chronic complications, sometimes severe, which may require specialised care.

These complications may be related to the dialysis session, vascular access, anticoagulant treatments, cardiovascular and metabolic disorders, or prolonged exposure to haemodialysis.

Some complications are common, while others are rare and complex. Their diagnosis can be difficult in patients with multiple comorbidities and may sometimes require the involvement of several specialties.

Complications may occur during or after a dialysis session, or develop gradually over the course of follow-up.

They include in particular:

• Hypotension and other haemodynamic complications during dialysis;
• Fluid, electrolyte and acid–base disorders;
• Cardiovascular complications;
• Reactions related to the dialyser or extracorporeal circuit;
• Haemorrhagic or thrombotic complications;
• Infections related to catheters or vascular access;
• Thrombosis, stenosis, aneurysms or other complications of arteriovenous fistulas;
• Mineral and bone disorders and vascular or valvular calcifications;
• Anaemia and malnutrition;
• Complications related to prolonged exposure to dialysis, particularly β2-microglobulin-related amyloidosis.

Some of these complications may lead to repeated hospitalisations, loss of vascular access, a reduced quality of life or, in the most severe cases, be life-threatening.

Specialist assessment is necessary, in particular, in the event of:

• Repeated or poorly tolerated hypotension during dialysis;
• Repeated difficulties in carrying out dialysis sessions;
• Prolonged or unusual bleeding after dialysis;
• Malfunction or thrombosis of a fistula or catheter;
• Signs of infection of the vascular access;
• Swelling, pain or changes in the appearance of the fistula;
• Cardiovascular or neurological disorders occurring during or after sessions;
• Persistent metabolic disorders despite treatment adjustment;
• Unexplained joint or bone pain in patients who have been on dialysis for a long time;
• Any unusual or difficult-to-explain complication.

Diagnosis is based on a comprehensive clinical and laboratory assessment tailored to each situation.

Depending on the suspected complication, investigations may include:

• Specialised clinical and laboratory assessment;
• Analysis of dialysis session parameters;
• Assessment of vascular access;
• Doppler ultrasound or specialised imaging;
• Cardiovascular examinations;
• Microbiological tests if an infection is suspected;
• Assessment of mineral, bone and nutritional parameters;
• Specialised investigations in the event of a rare or atypical complication.

The aim is to rapidly identify the cause of the complication in order to initiate appropriate treatment and, whenever possible, prevent its recurrence.

The management of complex haemodialysis complications at H.U.B. is based on close collaboration between the nephrology teams and the various specialties involved.

Nephrological expertise

Nephrologists assess and treat dialysis-related complications and adapt renal replacement therapy to each patient’s individual characteristics.

Particular attention is paid to preventing complications and preserving vascular access in order to maintain the quality and continuity of haemodialysis treatment.

Multidisciplinary care

Depending on the clinical situation, care may involve:

• Nephrology;
• Vascular surgery;
• Interventional radiology;
• Cardiology;
• Infectious diseases;
• Anaesthesia;
• Intensive care;
• Nutrition;
• Internal medicine;
• Renal transplantation.

This organisation enables rapid management of complications and facilitates access to specialised diagnostic and therapeutic techniques.

Particular expertise in vascular access

Vascular access is an essential component of haemodialysis treatment. Its preservation is therefore a priority.

H.U.B. has established close collaboration between nephrologists, vascular surgeons and interventional radiologists, enabling the diagnosis and management of thromboses, stenoses, infections and other complications affecting arteriovenous fistulas and catheters.

This approach aims to preserve vascular access and limit the need for catheters or the creation of new access sites.

Paediatric–adult collaboration and transition

Haemodialysis complications also affect children and adolescents requiring renal replacement therapy.

Within H.U.B., the paediatric nephrology teams at the Queen Fabiola Children’s University Hospital (HUDERF) and the adult nephrology team at Erasme Hospital collaborate to ensure continuity of care.

Particular attention is paid to the transition from paediatric to adult care. This gradual transition ensures continuity of follow-up, the transfer of medical information and the young patient’s progressive development of autonomy.

Research and innovation at H.U.B.

H.U.B. contributes to advancing knowledge in the field of chronic kidney disease, dialysis and its complications.

This activity helps improve the prevention, diagnosis and management of haemodialysis complications and, where relevant, enables patients to access clinical research projects or collaborations with specialised centres.

• Specialist expertise in nephrology and renal replacement therapy;
• Management of common, rare and complex complications of haemodialysis;
• Close collaboration between nephrology, vascular surgery and interventional radiology;
• Access to specialised technical facilities;
• Multidisciplinary management of complex situations;
• Collaboration between paediatric and adult nephrology;
• Organisation of the transition of patients from paediatric to adult care;
• Collaboration with the renal transplantation centre;
• Opportunities to participate in research projects and expert networks.