open access

Vol 2, No 1 (2017)
REVIEW ARTICLE
Published online: 2017-03-31
Get Citation

Emergency care of the dialysis patients

Lukasz Czyzewski, Janusz Wyzgal, Emilia Czyzewska, Lukasz Szarpak
DOI: 10.5603/DEMJ.2017.0007
·
Disaster Emerg Med J 2017;2(1):39-44.

open access

Vol 2, No 1 (2017)
REVIEW ARTICLE
Published online: 2017-03-31

Abstract

End stage renal disease (ESRD) is one of the major health care burdens worldwide. Emergency staff are well aware of the frequent use of their services by dialysis patients. In this article we discuss the urgent and serious medical problems that bring the dialysis patient to the emergency department (ED), and the special considerations in the management of such patients in the acute care setting. The main medical problems in dialysis patients presenting to the emergency department are as follows: emergent acid-base and electrolyte disorders; fever; cardiovascular emergencies; dyspnea; angina/chest pain; anemia and emergencies related to access. In conclusion, hemodialysis (HD) and peritoneal dialysis (PD) patients frequently utilize ED services because of their proneness to a variety of emergency medical problems.

Abstract

End stage renal disease (ESRD) is one of the major health care burdens worldwide. Emergency staff are well aware of the frequent use of their services by dialysis patients. In this article we discuss the urgent and serious medical problems that bring the dialysis patient to the emergency department (ED), and the special considerations in the management of such patients in the acute care setting. The main medical problems in dialysis patients presenting to the emergency department are as follows: emergent acid-base and electrolyte disorders; fever; cardiovascular emergencies; dyspnea; angina/chest pain; anemia and emergencies related to access. In conclusion, hemodialysis (HD) and peritoneal dialysis (PD) patients frequently utilize ED services because of their proneness to a variety of emergency medical problems.

Get Citation

Keywords

emergency care, treatment, dialysis, cardiography impedance

About this article
Title

Emergency care of the dialysis patients

Journal

Disaster and Emergency Medicine Journal

Issue

Vol 2, No 1 (2017)

Pages

39-44

Published online

2017-03-31

DOI

10.5603/DEMJ.2017.0007

Bibliographic record

Disaster Emerg Med J 2017;2(1):39-44.

Keywords

emergency care
treatment
dialysis
cardiography impedance

Authors

Lukasz Czyzewski
Janusz Wyzgal
Emilia Czyzewska
Lukasz Szarpak

References (38)
  1. National Kidney Foundation. K/DOQI clinical guidelines for chronic kidney disease: Evaluation, classification, and stratification. Am J Kidney Dis. 2002; 39(2 Suppl 1): S1–266.
  2. United States Renal Data System. 2016 USRDS annual data report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda 2016.
  3. Czyżewski L, Sańko-Resmer J, Wyzgał J, et al. Assessment of health-related quality of life of patients after kidney transplantation in comparison with hemodialysis and peritoneal dialysis. Ann Transplant. 2014; 19: 576–585.
  4. Surawicz B. Electrolytes and the electrocardiogram. Postgrad Med. 1974; 55(6): 123–129.
  5. Weisberg LS. Management of severe hyperkalemia. Critical Care Medicine. 2008; 36(12): 3246–3251.
  6. Salem MM. Hyperparathyroidism in the hemodialysis population: a survey of 612 patients. Am J Kidney Dis. 1997; 29(6): 862–865.
  7. Allon M, Maya ID, Carlton D, et al. Dialysis catheter-related bacteremia: treatment and prophylaxis. Am J Kidney Dis. 2004; 44(5): 779–791.
  8. Piraino B, Bailie GR, Bernardini J, et al. Peritoneal dialysis-related infections recommendations: update. Perit Dial Int. 2005; 25(2): 107–131.
  9. de Jager DJ, Grootendorst DC, Jager KJ, et al. Cardiovascular and noncardiovascular mortality among patients starting dialysis. JAMA. 2009; 302(16): 1782–1789.
  10. Curtis BM, Parfrey PS. Congestive heart failure in chronic kidney disease: disease-specific mechanisms of systolic and diastolic heart failure and management. Cardiol Clin. 2005; 23(3): 275–284.
  11. Padberg FT, Calligaro KD, Sidawy AN. Complications of arteriovenous hemodialysis access: recognition and management. J Vasc Surg. 2008; 48(5 Suppl): 55S–80S.
  12. Padberg FT, Calligaro KD, Sidawy AN. Complications of arteriovenous hemodialysis access: recognition and management. J Vasc Surg. 2008; 48(5 Suppl): 55S–80S.
  13. Montenij LJ, de Waal EEC, Buhre WF. Arterial waveform analysis in anesthesia and critical care. Curr Opin Anaesthesiol. 2011; 24(6): 651–656.
  14. Boldt J, Kling D, Thiel A, et al. Non-invasive versus invasive cardiovascular monitoring. Determination of stroke volume and pulmonary hydration using a new bioimpedance monitor. Anaesthesist. 1988; 37(4): 218–223.
  15. Strobeck JE, Silver MA. Beyond the four quadrants: the critical and emerging role of impedance cardiography in heart failure. Congest Heart Fail. 2004; 10(2 Suppl 2): 1–6.
  16. Kossari N, Hufnagel G, Squara P. Bioreactance: a new tool for cardiac output and thoracic fluid content monitoring during hemodialysis. Hemodial Int. 2009; 13(4): 512–517.
  17. Chittock DR, Dhingra VK, Ronco JJ, et al. Severity of illness and risk of death associated with pulmonary artery catheter use. Crit Care Med. 2004; 32(4): 911–915.
  18. Greenberg BH, Hermann DD, Pranulis MF, et al. Reproducibility of impedance cardiography hemodynamic measures in clinically stable heart failure patients. Congest Heart Fail. 2000; 6(2): 74–80.
  19. Cheung H, Dong Q, Dong R, et al. Correlation of cardiac output measured by non-invasive continuous cardiac output monitoring (NICOM) and thermodilution in patients undergoing off-pump coronary artery bypass surgery. J Anesth. 2015; 29(3): 416–420.
  20. Cotter G, Moshkovitz Y, Kaluski E, et al. Accurate, noninvasive continuous monitoring of cardiac output by whole-body electrical bioimpedance. Chest. 2004; 125(4): 1431–1440.
  21. Daugirdas JT. Pathophysiology of dialysis hypotension: an update. Am J Kidney Dis. 2001; 38(4 Suppl 4): S11–S17.
  22. Davenport A. Intradialytic complications during hemodialysis. Hemodial Int. 2006; 10(2): 162–167.
  23. Schreiber MJ. Clinical case-based approach to understanding intradialytic hypotension. Am J Kidney Dis. 2001; 38(4 Suppl 4): S37–S47.
  24. Karakitsos D, Wachtel M, Zerefos N, et al. Prognostic utility of impedance cardiography measurements in elderly hemodialysis patients with coronary artery disease. Am J Nephrol. 2009; 29(5): 426–433.
  25. Peyton PJ, Chong SW. Minimally invasive measurement of cardiac output during surgery and critical care: a meta-analysis of accuracy and precision. Anesthesiology. 2010; 113(5): 1220–1235.
  26. Hirschl MM, Kittler H, Woisetschläger C, et al. Simultaneous comparison of thoracic bioimpedance and arterial pulse waveform-derived cardiac output with thermodilution measurement. Crit Care Med. 2000; 28(6): 1798–1802.
  27. Engoren M, Barbee D. Comparison of cardiac output determined by bioimpedance, thermodilution, and the Fick method. Am J Crit Care. 2005; 14(1): 40–45.
  28. Gujjar AR, Muralidhar K, Banakal S, et al. Non-invasive cardiac output by transthoracic electrical bioimpedence in post-cardiac surgery patients: comparison with thermodilution method. J Clin Monit Comput. 2008; 22(3): 175–180.
  29. Wynne JL, Ovadje LO, Akridge CM, et al. Impedance cardiography: a potential monitor for hemodialysis. J Surg Res. 2006; 133(1): 55–60.
  30. Nicholls A. Heart and circulation. In: Daugirdas JT, Blake PG, Ing TS. ed. Handbook of dialysis. 3rd ed. Lippincott Williams and Wilkins, Philadelphia 2001.
  31. Saad E, Charra B, Raj DSC. Hypertension control with daily dialysis. Semin Dial. 2004; 17(4): 295–298.
  32. Lameire N. Volume control in peritoneal dialysis patients: role of new dialysis solutions. Blood Purif. 2004; 22(1): 44–54.
  33. Chen YC, Lin CJ, Wu CJ, et al. Comparison of extracellular volume and blood pressure in hemodialysis and peritoneal dialysis patients. Nephron Clin Pract. 2009; 113(2): c112–c116.
  34. van Biesen W, Claes K, Covic A, et al. A multicentric, international matched pair analysis of body composition in peritoneal dialysis versus haemodialysis patients. Nephrol Dial Transplant. 2013; 28(10): 2620–2628.
  35. Kalantar-Zadeh K, Regidor DL, Kovesdy CP, et al. Fluid retention is associated with cardiovascular mortality in patients undergoing long-term hemodialysis. Circulation. 2009; 119(5): 671–679.
  36. O'Hanlon R, Reddan DN. Treatment of acute coronary syndromes in patients who have chronic kidney disease. Med Clin North Am. 2005; 89(3): 563–585.
  37. Chronic Kidney Disease: National Clinical Guideline for Early Identification and Management in Adults in Primary and Secondary Care. National Collaborating Centre for Chronic Conditions (UK). Royal College of Physicians, London 2008.
  38. Czyżewski L, Sańko-Resmer J, Wyzgał J, et al. Comparative analysis of hypertension and its causes among renal replacement therapy patients. Ann Transplant. 2014; 19: 556–568.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl