Haroon Hamid, Iqbal Ahmed, Agha Shabbir Ali, Farkhanda Hafeez, Sajid Maqbool.
Acute complications of Hemodialysis in children.
Pak Paed J Jan ;27(3):108-12.

Introduction: The incidence of end stage renal disease requiring renal replacement therapy has been increasing in the pediatric population and hemodialysis remains one of the important modalities in this regard. The success of hemodialysis is confounded by many technical and medical factors. The complications developing during the procedure were studied. Objective: To study various complications arising during hemodialysis. Design: It is an observational and descriptive study. Place & Duration: The study was conducted at the Nephrology and Hemodialysis Unit of the Children`s Hospital, Lahore from January 2001 to June 2001. Patients & Methods: One hundred consecutive procedures of hemodialysis in children aged 5-16 years were monitored in children of End Stage Renal Disease (ESRD) for acute complications related to dialysis. Pre dialysis assessment was done before each procedure and pertinent investigations carried out. Dialysis was done on Cobe, Centry System 3 Dialysis Control Unit by a trained nurse. Results: A total of 100 hemodialysis procedures were observed in 13 children with a mean age of 11.19 years. Half of these children were male. Majority had height and weight less than 5`h percentile. A total of 63 procedures were complicated by one or more problems. Cardiovascular complications were most frequently observed; hypotension in 13 and hypertension in 50 procedures. Gastrointestinal complications included nausea / vomiting 30, pain epigastrium 18 and hematemesis 3. Neurological complications were headache 12, disorientation 5, fits 5 and vertigo 3. Respiratory distress was seen in 20 %, chest pain in 15% and cyanosis in 5%. Vascular access was complicated by infection in 23 procedures, thrombosis in 6, bleeding in 7 and dislodgment in 2 procedures. Majority of complications (46/63) required little or no intervention while only 10 complications resulted in discontinuation of the procedure; however there was no fatality resulting from these complications. Conclusions: Acute complications are not uncommon in pediatric hemodialysis. Majority, however, are mild to moderate in severity. Pre-dialysis assessment and vigilant monitoring is suggested to decrease these complications.

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