چکیده
Background: The safety of haemodialysis (HD) procedure has improved greatly over the years but, the procedure is not without risks; complications still occur during dialysis. In this study, we report on the pattern of intradialytic complications seen over a one year period at the dialysis centre of the Lagos University Teaching Hospital Lagos (LUTH), Nigeria.
Method: We reviewed the dialysis and hospital records of consecutive patients with chronic kidney disease (CKD) who received haemodialysis treatment in the dialysis centre during the period between January and December 2010. Data comprised patients’ demographics, aetiology of kidney failure and complications encountered during the HD treatment sessions.
Results: The study involved 201 patients with CKD; there were 113 (56.2%) males, the mean age was 47.5 ± 15.7years. There were 140 (69.7%) new patients and 61 (30.3%) old patients. The most common aetiology of CKD was hypertension (42.8%) followed by glomerulonephritis (15.9%). A total of 1010 haemodialysis sessions were recorded with complications occurring in 36.2% of the HD sessions. The most frequently encountered complication was hypertension which occurred in 15.2% of HD sessions followed by hypotension 8.5%. Hypotension occurred more frequently during first HD session (18.4%) compared with subsequent sessions (6.1%) X2 = p < 0.001. Patients who experienced hypertension had significantly higher pre-dialysis systolic blood pressure (BP) values (mean 168 ± 28.6mmHg vs 149.3 ± 20.1mmHg) and pre-dialysis diastolic BP (100.6 ± 18mmHg vs 90.3 ± 11.4mmHg) compared with those who did not. p < 0.001.
Conclusion: Hypertension was the most frequently encountered complication. Hypotension was still commonly encountered especially during first HD treatments. Clinicians must make concerted to optimise blood pressure in patients undergoing haemodialysis therapy.
Keywords: Haemodialysis complications, hypotension, hypertension, clotted dialyzers
Résumé
Contexte: La procédure de la sécurité de l’hémodialyse (HD) s’est beaucoup améliorée au fil des ans, mais la procédure n’est pas sans risque. Les complications se produisent toujours pendant la dialyse. Dans cette étude, nous présentons le modèle de complications intradialytiques observées pendant une période d’un an au centre de dialyse de l’Université de Lagos, Centre Hospitalier Universitaire de Lagos (LUTH), au Nigeria.
Méthode: Nous avons revu les dossiers des patients de dialyse consécutivement atteints de maladie rénale chronique (MRC) et qui ont reçu un traitement d’hémodialyse dans le centre de dialyse au cours de la période entre Janvier et Décembre 2010. Les données comprenaient les données démographiques des patients, l’étiologie de l’insuffisance rénale et les complications rencontrées lors des séances de traitement HD.
Résultats: L’étude a fait intervenir 201 patients atteints de néphropathie chronique, il y avait 113 (56,2%) hommes, dont l’âge moyen était de 47,5 ± 15,7 ans. Il y avait 140 (69,7%) nouveaux patients et 61 anciens patients (30,3%). L’étiologie la plus fréquente des maladies rénales chroniques était l’hypertension (42,8%), suivie de la glomérulonéphrite (15,9%). Un total de 1010 séances d’hémodialyse ont été enregistrées avec des complications survenant dans 36,2% des séances de HD. La complication la plus fréquemment rencontrée était l’hypertension qui a eu lieu dans 15,2% des séances de HD suivies d’une hypotension 8,5%.L’hypotension s’observe plus fréquemment pendant la première session d’HD (18,4%) contrairement aux sessions ultérieures (6,1%) X2 = p <0,001. Le nombre des patients souffrant de l’hypertension était plus élevé que ceux souffrant de pré-dialyse pression artérielle (TA) systolique dont la valeur est (moyenne 168 ± 149,3 ± 28,6mmHg contre 20,1mmHg) et de pré-dialyse diastolique (100,6 ± 90,3 contre 18mmHg ± 11,4mmHg) par rapport à ceux qui n’en souffrent pas p <0,001.
Conclusion: L’hypertension artérielle reste la complication la plus fréquemment rencontrée. On remarquait encore communément l’hypotension en particulier lors des premiers traitements d’HD. Les cliniciens doivent faire beaucoup d’effort afin d’optimiser la pression artérielle chez les patients qui sont soumis à un traitement d’hémodialyse.
Correspondence: Dr. C.O. Amira, Department of Medicine, College of Medicine, University of Lagos, PMB 12003, IdiAraba, Lagos, Nigeria. E-mail: toyinamira@yahoo.com
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