NCLEX Review Guide: Complications of Hemodialysis

Hypotension and Fluid Shifts

• Hypotension is the most common complication, occurring in 20-30% of treatments due to rapid fluid removal and electrolyte shifts. Monitor BP every 15-30 minutes and reduce ultrafiltration rate if systolic BP drops >20 mmHg from baseline.
• Disequilibrium syndrome occurs when urea is removed faster than it can cross the blood-brain barrier, causing cerebral edema. Symptoms include headache, nausea, confusion, and seizures - more common in first-time dialysis patients.

Electrolyte Imbalances

• Hypokalemia can cause dangerous cardiac arrhythmias during dialysis, especially if patient takes digoxin. Monitor cardiac rhythm continuously and check potassium levels before each treatment.
• Hyperkalemia rebound may occur 2-4 hours post-dialysis as potassium shifts from intracellular to extracellular space, requiring post-treatment monitoring.

AV Fistula and Graft Issues

• Thrombosis is indicated by absence of thrill or bruit, requiring immediate intervention to prevent permanent access loss. Never take BP, start IVs, or draw blood from the access arm.
• Steal syndrome occurs when the fistula diverts too much blood flow, causing ischemia distal to the access site with symptoms of coldness, numbness, and pain in fingers.

1. Assess access site for thrill and bruit before each treatment
2. Inspect for signs of infection (redness, warmth, drainage)
3. Monitor for adequate blood flow rates during dialysis
4. Educate patient on proper access care and protection

Cardiovascular and Bone Disease

• Cardiovascular disease is the leading cause of death in dialysis patients due to chronic inflammation, fluid overload, and electrolyte imbalances. Monitor for signs of heart failure and pericarditis.
• Renal osteodystrophy develops from chronic phosphorus retention and decreased vitamin D activation, leading to bone pain, fractures, and growth retardation in children.