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Non-infectious Complications of Hemodialysis in Children

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Pediatric Dialysis

Abstract

Hemodialysis (HD) is life-sustaining therapy utilized in the management of both acute kidney injury and end-stage renal disease (ESRD). Advances in dialysis technology in the last 5 decades have vastly improved the safety and efficacy of HD. However, acute and technical problems may occur during initiation of dialysis and during chronic HD treatments. Conventional HD imperfectly replaces renal function and may be associated with chronic long-term consequences. This chapter reviews acute and chronic complications associated with HD.

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References

  1. Kennedy AC, Linton AL, Eaton JC. Urea levels in cerebrospinal fluid after haemodialysis. Lancet. 1962;1(7226):410–1.

    Article  CAS  PubMed  Google Scholar 

  2. Patel N, Dalal P, Panesar M. Dialysis disequilibrium syndrome: a narrative review. Semin Dial. 2008;21(5):493–8.

    Article  PubMed  Google Scholar 

  3. Bagshaw SM, Peets AD, Hameed M, Boiteau PJ, Laupland KB, Doig CJ. Dialysis disequilibrium syndrome: brain death following hemodialysis for metabolic acidosis and acute renal failure--a case report. BMC Nephrol. 2004;5:9.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Yee M, Jern Y, Seng C. Dialysis disequilibrium syndrome: a preventable fatal acute complication. Med J Malaysia. 2016;71(2):91–2.

    Google Scholar 

  5. Harris CP, Townsend JJ. Dialysis disequilibrium syndrome. West J Med. 1989;151(1):52–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Zepeda-Orozco D, Quigley R. Dialysis disequilibrium syndrome. Pediatr Nephrol. 2012;27(12):2205–11.

    Article  PubMed  PubMed Central  Google Scholar 

  7. William JH, Gilbert AL, Rosas SE. Keeping an eye on dialysis: the association of hemodialysis with intraocular hypertension. Clin Nephrol. 2015;84(5):307–10.

    Article  PubMed  Google Scholar 

  8. Lund A, Damholt MB, Strange DG, Kelsen J, Moller-Sorensen H, Moller K. Increased intracranial pressure during hemodialysis in a patient with anoxic brain injury. Case Rep Crit Care. 2017;2017:5378928.

    PubMed  PubMed Central  Google Scholar 

  9. Esnault P, Lacroix G, Cungi PJ, D'Aranda E, Cotte J, Goutorbe P. Dialysis disequilibrium syndrome in neurointensive care unit: the benefit of intracranial pressure monitoring. Crit Care. 2012;16(6):472.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Rosen SM, O'Connor K, Shaldon S. Haemodialysis disequilibrium. Br Med J. 1964;2(5410):672–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Trinh-Trang-Tan MM, Cartron JP, Bankir L. Molecular basis for the dialysis disequilibrium syndrome: altered aquaporin and urea transporter expression in the brain. Nephrol Dial Transplant. 2005;20(9):1984–8.

    Article  CAS  PubMed  Google Scholar 

  12. Tuchman S, Khademian ZP, Mistry K. Dialysis disequilibrium syndrome occurring during continuous renal replacement therapy. Clin Kidney J. 2013;6(5):526–9.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Port FK, Johnson WJ, Klass DW. Prevention of dialysis disequilibrium syndrome by use of high sodium concentration in the dialysate. Kidney Int. 1973;3(5):327–33.

    Article  CAS  PubMed  Google Scholar 

  14. Bansal VK, Bansal S. Nervous system disorders in dialysis patients. Handb Clin Neurol. 2014;119:395–404.

    Article  PubMed  Google Scholar 

  15. Chang CH, Hsu KT, Lee CH, Lee YC, Chiou TT, Chuang CH, et al. Leukoencephalopathy associated with dialysis disequilibrium syndrome. Ren Fail. 2007;29(5):631–4.

    Article  PubMed  Google Scholar 

  16. Sengupta P, Biswas S. Dialysis disequilibrium leading to posterior reversible encephalopathy syndrome in chronic renal failure. CEN Case Rep. 2016;5(2):154–7.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Sheth KN, Wu GF, Messé SR, Wolf RL, Kasner SE. Dialysis disequilibrium: another reversible posterior leukoencephalopathy syndrome? Clin Neurol Neurosurg. 2003;105(4):249–52.

    Article  PubMed  Google Scholar 

  18. Kooman J, Basci A, Pizzarelli F, Canaud B, Haage P, Fouque D, et al. EBPG guideline on haemodynamic instability. Nephrol Dial Transplant. 2007;22(Suppl 2):ii22–44.

    PubMed  Google Scholar 

  19. Workgroup KD. K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis. 2005;45(4 Suppl 3):S1–153.

    Google Scholar 

  20. Kuipers J, Oosterhuis JK, Krijnen WP, Dasselaar JJ, Gaillard CA, Westerhuis R, et al. Prevalence of intradialytic hypotension, clinical symptoms and nursing interventions--a three-months, prospective study of 3818 haemodialysis sessions. BMC Nephrol. 2016;17:21.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Sands JJ, Usvyat LA, Sullivan T, Segal JH, Zabetakis P, Kotanko P, et al. Intradialytic hypotension: frequency, sources of variation and correlation with clinical outcome. Hemodial Int. 2014;18(2):415–22.

    Article  PubMed  Google Scholar 

  22. Tisler A, Akocsi K, Harshegyi I, Varga G, Ferenczi S, Grosz M, et al. Comparison of dialysis and clinical characteristics of patients with frequent and occasional hemodialysis-associated hypotension. Kidney Blood Press Res. 2002;26:97–102.

    Article  Google Scholar 

  23. Hothi DK, Harvey E, Goia CM, Geary D. Blood-volume monitoring in paediatric haemodialysis. Pediatr Nephrol. 2008;23(5):813–20.

    Article  PubMed  Google Scholar 

  24. Hothi D. An investigation into the mechanisms, consequences and moderators of intradialytic hypotension in paediatric haemodialysis. London: University College London; 2009.

    Google Scholar 

  25. Reeves P, McCausland F. Mechanisms, clinical implications, and treatment of intradialytic hypotension. Clin J Am Soc Nephrol. 2018;13(8):1297–303.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Chesterton L, McIntyre C. The assessment of baroreflex sensitivity in patients with chronic kidney disease: implications for vasomotor instability. Curr Opin Nephrol Hypertens. 2005;1(4):586–91.

    Article  Google Scholar 

  27. Hothi DK, Rees L, Marek J, Burton J, McIntyre CW. Pediatric myocardial stunning underscores the cardiac toxicity of conventional hemodialysis treatments. Clin J Am Soc Nephrol. 2009;4(4):790–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Burton JO, Jefferies HJ, Selby NM, McIntyre CW. Hemodialysis-induced repetitive myocardial injury results in global and segmental reduction in systolic cardiac function. Clin J Am Soc Nephrol. 2009;4(12):1925–31.

    Article  PubMed  PubMed Central  Google Scholar 

  29. McIntyre CW, Burton JO, Selby NM, Leccisotti L, Korsheed S, Baker CS, et al. Hemodialysis-induced cardiac dysfunction is associated with an acute reduction in global and segmental myocardial blood flow. Clin J Am Soc Nephrol. 2008;3(1):19–26.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Charytan DM, Skali H, Shah NR, Veeranna V, Cheezum MK, Taqueti VR, et al. Coronary flow reserve is predictive of the risk of cardiovascular death regardless of chronic kidney disease stage. Kidney Int. 2018;93(2):501–9.

    Article  PubMed  Google Scholar 

  31. Fellner S, Lang R, Neumann A, Spencer K, Bushinsky D, Borow K. Physiological mechanisms for calcium-induced changes in systemic arterial pressure in stable dialysis patients. Hypertension. 1989;13:213–8.

    Article  CAS  PubMed  Google Scholar 

  32. Tessitore N, Santoro A, Panzetta GO, Wizemann V, Perez-Garcia R, Martinez Ara J, et al. Acetate-free biofiltration reduces intradialytic hypotension: a European multicenter randomized controlled trial. Blood Purif. 2012;34(3–4):354–63.

    Article  PubMed  Google Scholar 

  33. Zaloszyc A, Schaefer B, Schaefer F, Krid S, Salomon R, Niaudet P, et al. Hydration measurement by bioimpedance spectroscopy and blood pressure management in children on hemodialysis. Pediatr Nephrol. 2013;28(11):2169–77.

    Article  PubMed  Google Scholar 

  34. Milani GP, Groothoff JW, Vianello FA, Fossali EF, Paglialonga F, Edefonti A, et al. Bioimpedance and fluid status in children and adolescents treated with dialysis. Am J Kidney Dis. 2017;69(3):428–35.

    Article  PubMed  Google Scholar 

  35. Allinovi M, Saleem MA, Burgess O, Armstrong C, Hayes W. Finding covert fluid: methods for detecting volume overload in children on dialysis. Pediatr Nephrol. 2016;31(12):2327–35.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Allinovi M, Saleem M, Romagnani P, Nazerian P, Hayes W. Lung ultrasound: a novel technique for detecting fluid overload in children on dialysis. Nephrol Dial Transplant. 2017;32(3):541–7.

    PubMed  Google Scholar 

  37. Fischbach M, Edefonti A, Schroder C, Watson A. European Pediatric Dialysis Working G. Hemodialysis in children: general practical guidelines. Pediatr Nephrol. 2005;20(8):1054–66.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Fadel FI, Makar SH, Eskander AE, Aon AH. Decreasing intra-dialytic morbid events and assessment of dry weight in children on chronic hemodialysis using non-invasive changes in hematocrit. Saudi J Kidney Dis Transpl. 2014;25(5):1030–7.

    Article  PubMed  Google Scholar 

  39. Merouani A, Kechaou W, Litalien C, Ducruet T, Jouvet P. Impact of blood volume monitoring on fluid removal during intermittent hemodialysis of critically ill children with acute kidney injury. Nephrol Dial Transplant. 2011;26(10):3315–9.

    Article  PubMed  Google Scholar 

  40. Raina R, Lam S, Raheja H, Krishnappa V, Hothi D, Davenport A, et al. Pediatric intradialytic hypotension: recommendations from the Pediatric Continuous Renal Replacement Therapy (PCRRT) Workgroup. Pediatr Nephrol. 2019;34(5):925–41.

    Article  PubMed  Google Scholar 

  41. Dheu C, Terzic J, Menouer S, Fischbach M. Importance of the curve shape for interpretation of blood volume monitor changes during haemodiafiltration. Pediatr Nephrol. 2009;24(7):1419–23.

    Article  PubMed  Google Scholar 

  42. Candan C, Sever L, Civilibal M, Caliskan S, Arisoy N. Blood volume monitoring to adjust dry weight in hypertensive pediatric hemodialysis patients. Pediatr Nephrol. 2009;24(3):581–7.

    Article  PubMed  Google Scholar 

  43. Patel HP, Goldstein SL, Mahan JD, Smith B, Fried CB, Currier H, et al. A standard, noninvasive monitoring of hematocrit algorithm improves blood pressure control in pediatric hemodialysis patients. Clin J Am Soc Nephrol. 2007;2(2):252–7.

    Article  PubMed  Google Scholar 

  44. Paglialonga F, Consolo S, Edefonti A, Montini G. The first hour refill index: a promising marker of volume overload in children and young adults on chronic hemodialysis. Pediatr Nephrol. 2018;33(7):1209–14.

    Article  PubMed  Google Scholar 

  45. Kron S, Schneditz D, Leimbach T, Aign S, Kron J. Vascular refilling is not reduced in dialysis sessions with morbid events. Blood Purif. 2017;43(4):309–14.

    Article  PubMed  Google Scholar 

  46. Hothi DK, Harvey E, Goia CM, Geary DF. Evaluating methods for improving ultrafiltration in pediatric hemodialysis. Pediatr Nephrol. 2008;23(4):631–8.

    Article  PubMed  Google Scholar 

  47. Dunne N. A meta-analysis of sodium profiling techniques and the impact on intradialytic hypotension. Hemodial Int. 2017;21(3):312–22.

    Article  PubMed  Google Scholar 

  48. Locatelli F, Altieri P, Andrulli S, Sau G, Bolasco P, Pedrini LA, et al. Phosphate levels in patients treated with low-flux haemodialysis, pre-dilution haemofiltration and haemodiafiltration: post hoc analysis of a multicentre, randomized and controlled trial. Nephrol Dial Transplant. 2014;29(6):1239–46.

    Article  CAS  PubMed  Google Scholar 

  49. Shroff R, Smith C, Ranchin B, Bayazit AK, Stefanidis CJ, Askiti V, et al. Effects of hemodiafiltration versus conventional hemodialysis in children with ESKD: the HDF, heart and height study. J Am Soc Nephrol. 2019;30(4):678–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Donauer J. Reduction of hypotensive side effects during online-haemodiafiltration and low temperature haemodialysis. Nephrol Dial Transplant. 2003;18(8):1616–22.

    Article  PubMed  Google Scholar 

  51. Hothi DK, Harvey E, Goia CM, Geary D. The value of sequential dialysis, mannitol and midodrine in managing children prone to dialysis failure. Pediatr Nephrol. 2009;24(8):1587–91.

    Article  PubMed  Google Scholar 

  52. Chen J, Gul A, Sarnak M. Management of intradialytic hypertension: the ongoing challenge. Semin Dial. 2006;19(2):141–5.

    Article  PubMed  Google Scholar 

  53. Cirit M, Akcicek F, Terzioglu E, Soydas C, Ok E, Ozbasli C, et al. Paradoxical rise in blood pressure during ultrafiltration in dialysis patients. Nephrol Dial Transplant. 1995;10:1417–20.

    CAS  PubMed  Google Scholar 

  54. Park J, Rhee CM, Sim JJ, Kim YL, Ricks J, Streja E, et al. A comparative effectiveness research study of the change in blood pressure during hemodialysis treatment and survival. Kidney Int. 2013;84(4):795–802.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Geary DF, Piva E, Tyrrell J, Gajaria MJ, Picone G, Keating LE, et al. Home nocturnal hemodialysis in children. J Pediatr. 2005;147(3):383–7.

    Article  PubMed  Google Scholar 

  56. Warady BA, Fischbach M, Geary D, Goldstein SL. Frequent hemodialysis in children. Adv Chronic Kidney Dis. 2007;14(3):297–303.

    Article  PubMed  Google Scholar 

  57. Villarroel F, Ciarkowski AA. A survey on hypersensitivity reactions in hemodialysis. Artif Organs. 1985;9(3):231–8.

    Article  CAS  PubMed  Google Scholar 

  58. Daugirdas JT, Ing TS. First-use reactions during hemodialysis: a definition of subtypes. Kidney Int. 1988;33(Suppl 24):S37–43.

    Google Scholar 

  59. Salem M, Ivanovich PT, Ing TS, Daugirdas JT. Adverse effects of dialyzers manifesting during the dialysis session. Nephrol Dial Transplant. 1994;9(Suppl 2):127–37.

    PubMed  Google Scholar 

  60. Ebo DG, Bosmans JL, Couttenye MM, Stevens WJ. Haemodialysis-associated anaphylactic and anaphylactoid reactions. Allergy. 2006;61(2):211–20.

    Article  CAS  PubMed  Google Scholar 

  61. Lemke HD. Mediation of hypersensitivity reactions during hemodialysis by IgE antibodies against ethylene oxide. Artif Organs. 1987;11(2):104–10.

    Article  CAS  PubMed  Google Scholar 

  62. Nicholls A. Ethylene oxide and anaphylaxis during haemodialysis. Br Med J (Clin Res Ed). 1986;292(6530):1221–2.

    Article  CAS  Google Scholar 

  63. Caruana RJ, Hamilton RW, Pearson FC. Dialyzer hypersensitivity syndrome: possible role of allergy to ethylene oxide. Report of 4 cases and review of one literature. Am J Nephrol. 1985;5(4):271–4.

    Article  CAS  PubMed  Google Scholar 

  64. Pearson F, Bruszer G, Lee W, Sagona M, Sargent H, Woods E, et al. Ethylene oxide sensitivity in hemodialysis patients. Artif Organs. 1987;11(2):100–3.

    Article  CAS  PubMed  Google Scholar 

  65. Ansorge W, Pelger M, Dietrich W, Baurmeister U. Ethylene oxide in dialyzer rinsing fluid: effect of rinsing technique, dialyzer storage time, and potting compound. Artif Organs. 1987;11(2):118–22.

    Article  CAS  PubMed  Google Scholar 

  66. Kokubo K, Kurihara Y, Kobayashi K, Tsukao H, Kobayashi H. Evaluation of the biocompatibility of dialysis membranes. Blood Purif. 2015;40(4):293–7.

    Article  CAS  PubMed  Google Scholar 

  67. Bacelar Marques ID, Pinheiro KF, de Freitas do Carmo LP, Costa MC, Abensur H. Anaphylactic reaction induced by a polysulfone/polyvinylpyrrolidone membrane in the 10th session of hemodialysis with the same dialyzer. Hemodial Int. 2011;15(3):399–403.

    Article  PubMed  Google Scholar 

  68. Sayeed K, Murdakes C, Spec A, Gashti C. Anaphylactic shock at the beginning of hemodialysis. Semin Dial. 2016;29(1):81–4.

    Article  PubMed  Google Scholar 

  69. Hildebrand S, Corbett R, Duncan N, Ashby D. Increased prevalence of eosinophilia in a hemodialysis population: longitudinal and case control studies. Hemodial Int. 2016;20:414.

    Article  PubMed  Google Scholar 

  70. Li Z, Ma L, Zhao S. Effect of polyflux membranes on the improvement of hemodialysis-associated eosinophilia: a case series. Ren Fail. 2016;38(1):65–9.

    Article  PubMed  Google Scholar 

  71. Tielemans C, Madhoun P, Lenaers M, Schandene L, Goldman M, Vanherweghem JL. Anaphylactoid reactions during hemodialysis on AN69 membranes in patients receiving ACE inhibitors. Kidney Int. 1990;38(5):982–4.

    Article  CAS  PubMed  Google Scholar 

  72. Parnes EL, Shapiro WB. Anaphylactoid reactions in hemodialysis patients treated with the AN69 dialyzer. Kidney Int. 1991;40(6):1148–52.

    Article  CAS  PubMed  Google Scholar 

  73. Verresen L, Fink E, Lemke HD, Vanrenterghem Y. Bradykinin is a mediator of anaphylactoid reactions during hemodialysis with AN69 membranes. Kidney Int. 1994;45(5):1497–503.

    Article  CAS  PubMed  Google Scholar 

  74. Coppo R, Amore A, Cirina P, Scelfo B, Giacchino F, Comune L, et al. Bradykinin and nitric oxide generation by dialysis membranes can be blunted by alkaline rinsing solutions. Kidney Int. 2000;58(2):881–8.

    Article  CAS  PubMed  Google Scholar 

  75. Brophy PD, Mottes TA, Kudelka TL, McBryde KD, Gardner JJ, Maxvold NJ, et al. AN-69 membrane reactions are pH-dependent and preventable. Am J Kidney Dis. 2001;38(1):173–8.

    Article  CAS  PubMed  Google Scholar 

  76. Molinaro G, Duan QL, Chagnon M, Moreau ME, Simon P, Clavel P, et al. Kinin-dependent hypersensitivity reactions in hemodialysis: metabolic and genetic factors. Kidney Int. 2006;70(10):1823–31.

    Article  CAS  PubMed  Google Scholar 

  77. Berkun Y, Haviv YS, Schwartz LB, Shalit M. Heparin-induced recurrent anaphylaxis. Clin Exp Allergy. 2004;34(12):1916–8.

    Article  CAS  PubMed  Google Scholar 

  78. Syed S, Reilly RF. Heparin-induced thrombocytopenia: a renal perspective. Nat Rev Nephrol. 2009;5(9):501–11.

    Article  PubMed  Google Scholar 

  79. Blossom DB, Kallen AJ, Patel PR, Elward A, Robinson L, Gao G, et al. Outbreak of adverse reactions associated with contaminated heparin. N Engl J Med. 2008;359(25):2674–84.

    Article  CAS  PubMed  Google Scholar 

  80. Upadhyay A, Jaber BL. We use impure water to make dialysate for hemodialysis. Semin Dial. 2016;29(4):297–9.

    Article  PubMed  Google Scholar 

  81. Ward RA. Ultrapure dialysate. Semin Dial. 2004;17(6):489–97.

    Article  PubMed  Google Scholar 

  82. Upadhyay A, Sosa MA, Jaber BL. Single-use versus reusable dialyzers: the known unknowns. Clin J Am Soc Nephrol. 2007;2(5):1079–86.

    Article  PubMed  Google Scholar 

  83. Twardowski ZJ. Dialyzer reuse - part II: advantages and disadvantages. Semin Dial. 2006;19(3):41–53.

    Article  PubMed  Google Scholar 

  84. Canaud B, Aljama P, Tielemans C, Gasparovic V, Gutierrez A, Locatelli F. Pathochemical toxicity of perfluorocarbon-5070, a liquid test performance fluid previously used in dialyzer manufacturing, confirmed in animal experiment. J Am Soc Nephrol. 2005;16(6):1819–23.

    Article  CAS  PubMed  Google Scholar 

  85. Daugirdas JT, Bernardo AA. Hemodialysis effect on platelet count and function and hemodialysis-associated thrombocytopenia. Kidney Int. 2012;82(2):147–57.

    Article  CAS  PubMed  Google Scholar 

  86. Kiaii M, Djurdjev O, Farah M, Levin A, Jung B, MacRae J. Use of electron-beam sterilized hemodialysis membranes and risk of thrombocytopenia. JAMA. 2011;306(15):1679–87.

    Article  CAS  PubMed  Google Scholar 

  87. De Prada L, Lee J, Gillespie A, Benjamin J. Thrombocytopenia associated with one type of polysulfone hemodialysis membrane: a report of 5 cases. Am J Kidney Dis. 2013;61(1):131–3.

    Article  PubMed  CAS  Google Scholar 

  88. Muraro A, Roberts G, Clark A, Eigenmann PA, Halken S, Lack G, et al. The management of anaphylaxis in childhood: position paper of the European academy of allergy and clinical immunology. Allergy. 2007;62(8):857–71.

    Article  CAS  PubMed  Google Scholar 

  89. Capozzoli G, Schenk C, Vezzali N. Cerebral air embolism after central dialysis line removal: the role of the fibrin sheath as portal (mechanism) of air entry. J Vasc Access. 2012;13(4):516–9.

    Article  PubMed  Google Scholar 

  90. Sahutoglu T, Sakaci T, Hasbal NB, Kara E, Ahbap E, Sevinc M, et al. Air embolism following removal of hemodialysis catheter. Hemodial Int. 2017;21(1):29–34.

    Article  PubMed  Google Scholar 

  91. Wong SS, Kwaan HC, Ing TS. Venous air embolism related to the use of central catheters revisited: with emphasis on dialysis catheters. Clin Kidney J. 2017;10(6):797–803.

    Article  PubMed  PubMed Central  Google Scholar 

  92. Stegmayr B. Air contamination during hemodialysis should be minimized. Hemodial Int. 2017;21(2):168–72.

    Article  PubMed  Google Scholar 

  93. Stegmayr B, Forsberg U, Jonsson P, Stegmayr C. The sensor in the venous chamber does not prevent passage of air bubbles during hemodialysis. Artif Organs. 2007;31(2):162–6.

    Article  PubMed  Google Scholar 

  94. Ward M, Shadforth M, Hill A, Kerr D. Air embolism during haemodialysis. Br Med J. 1971;3(5766):74–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  95. Baskin S, Wozniak R. Hyperbaric oxygenation in the treatment of hemodialysis-associated air embolism. N Engl J Med. 1975;293(4):184–5.

    Article  CAS  PubMed  Google Scholar 

  96. Dunbar E, Fox R, Watson B, Akrill P. Successful late treatment of venous air embolism with hyperbaric oxygen. Postgrad Med J. 1990;66(776):469–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  97. Lau L, London K. Cortical blindness and altered mental status following routine hemodialysis, a case of iatrogenic cerebral air embolism. Case Rep Emerg Med. 2018;2018:9496818.

    PubMed  PubMed Central  Google Scholar 

  98. Jonsson P, Lindmark L, Axelsson J, Karlsson L, Lundberg L, Stegmayr B. Formation of blood foam in the air trap during hemodialysis due to insufficient automatic priming of dialyzers. Artif Organs. 2018;42(5):533–9.

    Article  CAS  PubMed  Google Scholar 

  99. Jonsson P, Karlsson L, Forsberg U, Gref M, Stegmayr C, Stegmayr B. Air bubbles pass the security system of the dialysis device without alarming. Artif Organs. 2007;31(2):132–9.

    Article  PubMed  Google Scholar 

  100. Keshavarzi G, Barber TJ, Yeoh G, Simmons A, Reizes JA. Two-dimensional computational analysis of microbubbles in hemodialysis. Artif Organs. 2013;37(8):E139–44.

    Article  PubMed  Google Scholar 

  101. Keshavarzi G, Simmons A, Yeoh G, Barber T. Effectiveness of microbubble removal in an airtrap with a free surface interface. J Biomech. 2015;48(7):1237–40.

    Article  PubMed  Google Scholar 

  102. Barak M, Nakhoul F, Katz Y. Pathophysiology and clinical implications of microbubbles during hemodialysis. Semin Dial. 2008;21(3):232–8.

    Article  PubMed  Google Scholar 

  103. Polaschegg H. Hemodialysis machine air detectors need not detect microbubbles. Artif Organs. 2007;31(12):911–2.

    Article  PubMed  Google Scholar 

  104. Wagner S, Rode C, Wojke R, Canaud B. Observation of microbubbles during standard dialysis treatments. Clin Kidney J. 2015;8(4):400–4.

    Article  PubMed  PubMed Central  Google Scholar 

  105. Forsberg U, Jonsson P, Stegmayr C, Jonsson F, Nilsson B, Nilsson Ekdahl K, et al. A high blood level in the venous chamber and a wet-stored dialyzer help to reduce exposure for microemboli during hemodialysis. Hemodial Int. 2013;17(4):612–7.

    PubMed  Google Scholar 

  106. Stegmayr BG. Sources of mortality on dialysis with an emphasis on microemboli. Semin Dial. 2016;29(6):442–6.

    Article  PubMed  Google Scholar 

  107. Kosmadakis G, Aguilera D, Carceles O, Da Costa Correia E, Boletis I. Pulmonary hypertension in dialysis patients. Ren Fail. 2013;35(4):514–20.

    Article  PubMed  Google Scholar 

  108. Stegmayr B, Brannstrom T, Forsberg U, Jonson P, Stegmayr C, Hultdin J. Microbubbles of air may occur in the organs of hemodialysis patients. ASAIO J. 2012;58(2):177–9.

    Article  PubMed  Google Scholar 

  109. Madero M, Sarnak MJ. Does hemodialysis hurt the brain? Semin Dial. 2011;24(3):266–8.

    Article  PubMed  Google Scholar 

  110. Forsberg U, Jonsson P, Stegmayr C, Stegmayr B. Microemboli, developed during haemodialysis, pass the lung barrier and may cause ischaemic lesions in organs such as the brain. Nephrol Dial Transplant. 2010;25(8):2691–5.

    Article  PubMed  Google Scholar 

  111. George S, Holt S, Hildick-Smith D. Patent foramen ovale, dialysis and microembolization. Nephrology. 2012;17(6):569–74.

    Article  PubMed  Google Scholar 

  112. Forsberg U, Jonsson P, Stegmayr C, Stegmayr B. A high blood level in the air trap reduces microemboli during hemodialysis. Artif Organs. 2012;36(6):525–9.

    Article  PubMed  Google Scholar 

  113. Palanchon P, Birmele B, Tranquart F. Acoustical bubble trapper applied to hemodialysis. Ultrasound Med Biol. 2008;34(4):681–4.

    Article  CAS  PubMed  Google Scholar 

  114. Lindley E, Finney D, Jones P, Lewington A, O'Reagan A, Webb G. Unexpected triggering of the dialysate blood leak detector by haemolysis. Acta Clin Belg. 2015;70(3):226–9.

    Article  CAS  PubMed  Google Scholar 

  115. Avila J, Prasad D, Weisberg L, Kasama R. Pseudo-blood leak? A hemodialysis mystery. J Clin Nephrol. 2013;79(4):323–5.

    Article  Google Scholar 

  116. Lim K, Heher E, Steele D, Fenves A, Tucker J, Thadhani R, et al. Hemodialysis failure secondary to hydroxyocobalamin exposure. Proc (Bayl Univ Med Cent). 2017;30(2):167–8.

    Article  Google Scholar 

  117. Gizaw A, Kidd JM. All that leaks is not blood. Kidney Int. 2015;88(3):645.

    Article  PubMed  Google Scholar 

  118. Tharmaraj D, Kerr PG. Haemolysis in haemodialysis. Nephrology. 2017;22(11):838–47.

    Article  PubMed  Google Scholar 

  119. Kirsch AH, Pollheimer MJ, Troppan K, Horina JH, Rosenkranz AR, Eller K. The case | acute kidney injury and hemolysis in a 58-year-old woman. Kidney Int. 2017;91(4):993–4.

    Article  PubMed  Google Scholar 

  120. Malinauskas R. Decreased hemodialysis circuit pressures indicating postpump tubing kinks: a retrospective investigation of hemolysis in five patients. Hemodial Int. 2008;12(3):383–93.

    Article  PubMed  Google Scholar 

  121. Paluszkiewicz A, Kellner J, Elshehabi M, Schneditz D. Effect of hemolysis and free hemoglobin on optical hematocrit measurements in the extracorporeal circulation. ASAIO J. 2008;54(2):181–4.

    Article  PubMed  Google Scholar 

  122. (CDC) CfDCaP. Multistate outbreak of hemolysis in hemodialysis patients - Nebraska and Maryland. MMWR Morb Mortal Wkly Rep. 1998;47(23):483–4.

    Google Scholar 

  123. Duffy R, Tomashek K, Spangenberg M, Spry L, Dwyer D, Safranek TJ, et al. Multistate outbreak of hemolysis in hemodialysis patients traced to faulty blood tubing sets. Kidney Int. 2000;57(4):1668–74.

    Article  CAS  PubMed  Google Scholar 

  124. Abtahi M, Uzan M, Souid M. Hemolysis-induced acute pancreatitis secondary to kinked hemodialysis blood lines. Hemodial Int. 2007;11(1):38–41.

    Article  PubMed  Google Scholar 

  125. Gault M, Duffett S, Purchase L, Murphy J. Hemodialysis intravascular hemolysis and kinked blood lines. Nephron. 1992;62(3):267–71.

    Article  CAS  PubMed  Google Scholar 

  126. Sweet S, McCarthy S, Steingart R, Callahan T. Hemolytic reactions mechanically induced by kinked hemodialysis lines. Am J Kidney Dis. 1996;27(2):262–6.

    Article  CAS  PubMed  Google Scholar 

  127. Shibata E, Nagai K, Takeuchi R, Noda Y, Makino T, Chikata Y, et al. Re-evaluation of pre-pump arterial pressure to avoid inadequate dialysis and hemolysis: importance of prepump arterial pressure monitoring in hemodialysis patients. Artif Organs. 2015;39(7):627–34.

    Article  PubMed  Google Scholar 

  128. Yoon J, Thapa S, Chow R, Jaar B. Hemolysis as a rare but potentially life-threatening complication of hemodialysis: a case report. BMC Res Notes. 2014;7:475.

    Article  PubMed  PubMed Central  Google Scholar 

  129. Polaschegg HD. Red blood cell damage from extracorporeal circulation in hemodialysis. Semin Dial. 2009;22(5):524–31.

    Article  PubMed  Google Scholar 

  130. Techert F, Techert S, Woo L, Beck W, Lebsanft H, Wizemann V. High blood flow rates with adjustment of needle diameter do not increase hemolysis during hemodialysis treatment. J Vasc Access. 2007;8(4):252–7.

    Article  CAS  PubMed  Google Scholar 

  131. Mehta HK, Deabreu D, McDougall JG, Goldstein MB. Correction of discrepancy between prescribed and actual blood flow rates in chronic hemodialysis patients with use of larger gauge needles. Am J Kidney Dis. 2002;39(6):1231–5.

    Article  PubMed  Google Scholar 

  132. Berkes S, Kahn S, Chazan J, Garella S. Prolonged hemolysis from overheated dialysate. Ann Intern Med. 1975;83(3):363.

    Article  CAS  PubMed  Google Scholar 

  133. Pendergrast JM, Hladunewich MA, Richardson RM. Hemolysis due to inadvertent hemodialysis against distilled water: perils of bedside dialysate preparation. Crit Care Med. 2006;34(10):2666–73.

    Article  PubMed  Google Scholar 

  134. Matter B, Pederson J, Psimenos G, Lindeman R. Lethal copper intoxication in hemodialysis. Trans Am Soc Artif Intern Organs. 1969;15:309–15.

    CAS  PubMed  Google Scholar 

  135. Orringer E, Mattern W. Formaldehyde-induced hemolysis during chronic hemodialysis. N Engl J Med. 1976;294(26):1416–20.

    Article  CAS  PubMed  Google Scholar 

  136. Punn K, Yeung C, Chen T. Acute intravascular hemolysis due to accidental formalin intoxication during hemodialysis. Clin Nephrol. 1984;21(3):188–90.

    Google Scholar 

  137. de Oliveira RM, de los Santos CA, Antonello I, d'Avila D. Warning: an anemia outbreak due to chloramine exposure in a clean hemodialysis unit--an issue to be revisited. Ren Fail. 2009;31(1):81–3.

    Article  PubMed  CAS  Google Scholar 

  138. Pengo MF, Ioratti D, Bisogni V, Ravarotto V, Rossi B, Bonfante L, et al. In patients with chronic kidney disease short term blood pressure variability is associated with the presence and severity of sleep disorders. Kidney Blood Press Res. 2017;42(5):804–15.

    Article  PubMed  Google Scholar 

  139. Scherer JS, Combs SA, Brennan F. Sleep disorders, restless legs syndrome, and uremic pruritus: diagnosis and treatment of common symptoms in dialysis patients. Am J Kidney Dis. 2017;69(1):117–28.

    Article  PubMed  Google Scholar 

  140. Gerogianni G, Kouzoupis A, Grapsa E. A holistic approach to factors affecting depression in haemodialysis patients. Int Urol Nephrol. 2018;50(8):1467–76.

    Article  PubMed  Google Scholar 

  141. Davis ID, Baron J, O'Riordan MA, Rosen CL. Sleep disturbances in pediatric dialysis patients. Pediatr Nephrol. 2005;20(1):69–75.

    Article  PubMed  Google Scholar 

  142. Davis ID, Greenbaum LA, Gipson D, Wu LL, Sinha R, Matsuda-Abedini M, et al. Prevalence of sleep disturbances in children and adolescents with chronic kidney disease. Pediatr Nephrol. 2012;27(3):451–9.

    Article  PubMed  Google Scholar 

  143. El-Refaey A, Elsayed R, Sarhan A, Bakr A, Hammad A, Elmougy A, et al. Sleep quality assessment using polysomnography in children on regular hemodialysis. Saudi J Kidney Dis Transpl. 2013;24(4):714–8.

    Article  PubMed  Google Scholar 

  144. Amin R, Sharma N, Al-Mokali K, Sayal P, Al-Saleh S, Narang I, et al. Sleep-disordered breathing in children with chronic kidney disease. Pediatr Nephrol. 2015;30(12):2135–43.

    Article  PubMed  Google Scholar 

  145. Gomes C, Oliveira L, Ferreira R, Simao C. Sleep disturbance in pediatric patients on automated peritoneal dialysis. Sleep Med. 2017;32:87–91.

    Article  PubMed  Google Scholar 

  146. Allen RP, Picchietti DL, Garcia-Borreguero D, Ondo WG, Walters AS, Winkelman JW, et al. Restless legs syndrome/Willis-Ekbom disease diagnostic criteria: updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria--history, rationale, description, and significance. Sleep Med. 2014;15(8):860–73.

    Article  PubMed  Google Scholar 

  147. Applebee GA, Guillot AP, Schuman CC, Teddy S, Attarian HP. Restless legs syndrome in pediatric patients with chronic kidney disease. Pediatr Nephrol. 2009;24(3):545–8.

    Article  PubMed  Google Scholar 

  148. Riar SK, Leu RM, Turner-Green TC, Rye DB, Kendrick-Allwood SR, McCracken C, et al. Restless legs syndrome in children with chronic kidney disease. Pediatr Nephrol. 2013;28(5):773–95.

    Article  PubMed  Google Scholar 

  149. Kennedy C, Ryan SA, Kane T, Costello RW, Conlon PJ. The impact of change of renal replacement therapy modality on sleep quality in patients with end-stage renal disease: a systematic review and meta-analysis. J Nephrol. 2018;31(1):61–70.

    Article  CAS  PubMed  Google Scholar 

  150. Li L, Tang X, Kim S, Zhang Y, Li Y, Fu P. Effect of nocturnal hemodialysis on sleep parameters in patients with end-stage renal disease: a systematic review and meta-analysis. PLoS One. 2018;13(9):e0203710.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  151. Brekke FB, Waldum-Grevbo B, von der Lippe N, Os I. The effect of renal transplantation on quality of sleep in former dialysis patients. Transpl Int. 2017;30(1):49–56.

    Article  PubMed  Google Scholar 

  152. Ball E, Kara T, McNamara D, Edwards EA. Resolution of sleep-disordered breathing in a dialysis-dependent child post-renal transplantation. Pediatr Nephrol. 2010;25(1):173–7.

    Article  PubMed  Google Scholar 

  153. Sharma N, Harvey E, Amin R. Sleep-disordered breathing in 2 pediatric patients on peritoneal dialysis. Perit Dial Int. 2016;36(1):109–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  154. Stabouli S, Papadimitriou E, Printza N, Dotis J, Papachristou F. Sleep disorders in pediatric chronic kidney disease patients. Pediatr Nephrol. 2016;31(8):1221–9.

    Article  PubMed  Google Scholar 

  155. Fenves A, Emmett M, White M, Greenway G, Michaels D. Carpal tunnel syndrome with cystic bone lesions secondary to amyloidosis in chronic hemodialysis patients. Am J Kidney Dis. 1986;7(2):130–4.

    Article  CAS  PubMed  Google Scholar 

  156. Dulgheru EC, Balos LL, Baer AN. Gastrointestinal complications of beta2-microglobulin amyloidosis: a case report and review of the literature. Arthritis Rheum. 2005;53(1):142–5.

    Article  PubMed  Google Scholar 

  157. Jadoul M, Garbar C, Noël H, Sennesael J, Vanholder R, Bernaert P, et al. Histological prevalence of β2-microglobulin amyloidosis in hemodialysis: a prospective post-mortem study. Kidney Int. 1997;51(6):1928–32.

    Article  CAS  PubMed  Google Scholar 

  158. van Ypersele de Strihou C, Jadoul M, Malghem J, Maldague B, Jamart J. Effect of dialysis membrane and patient's age on signs of dialysis-related amyloidosis. The Working Party on Dialysis Amyloidosis. Kidney Int. 1991;39(5):1012–9.

    Article  Google Scholar 

  159. McCarthy J, Williams A, Johnson W. Serum beta 2-microglobulin concentration in dialysis patients: importance of intrinsic renal function. J Lab Clin Med. 1994;123(4):495–505.

    CAS  PubMed  Google Scholar 

  160. Dember L, Jaber B. Dialysis-related amyloidosis: late finding or hidden epidemic? Semin Dial. 2006;19(2):105–9.

    Article  PubMed  Google Scholar 

  161. Robindranath K, Strippoli G, Daly C, Roderick P, Wallace S, MacLeod A. Haemodiafiltration, haemofiltration and haemodialysis for end-stage kidney disease (Review). Cochrane Database Syst Rev. 2006;4:1–93.

    Google Scholar 

  162. Raj D, Ouwendyk M, Francoeur R, Pierratos A. b2-microglobulin kinetics in nocturnal haemodialysis. Nephrol Dial Transplant. 2000;15:58–64.

    Article  CAS  PubMed  Google Scholar 

  163. Schiffl H, D'Agostini B, Held E. Removal of beta 2-microglobulin by hemodialysis and hemofiltration: a four year follow up. Biomater Artif Cell Immobil Biotechnol. 1992;20(5):1223–32.

    CAS  Google Scholar 

  164. Lornoy W, Becaus I, Billiouw J, Sierens L, van Malderen P, D'Haenens P. On-line haemodiafiltration. Remarkable removel of b2-microglobulin. Long-term clinical observations. Nephrol Dial Transplant. 2000;15(1):49–54.

    Article  PubMed  Google Scholar 

  165. van Ypersele de Strihou C. b2-Microglobulin amyloidosis: effect of ESRF treatment modality and dialysis membrane type. Nephrol Dial Transplant. 1996;11(2):147–9.

    Article  Google Scholar 

  166. Ward RA, Greene T, Hartmann B, Samtleben W. Resistance to intercompartmental mass transfer limits beta2-microglobulin removal by post-dilution hemodiafiltration. Kidney Int. 2006;69(8):1431–7.

    Article  CAS  PubMed  Google Scholar 

  167. van Ypersele de Strihou C, Floege J, Jadoul M, Koch K. Amyloidosis and its relationship to different dialysers. Nephrol Dial Transplant. 1994;9(Suppl 2):156–61.

    Google Scholar 

  168. Drueke TB, Massy ZA. Beta2-microglobulin. Semin Dial. 2009;22(4):378–80.

    Article  PubMed  Google Scholar 

  169. Flythe JE, Hilliard T, Castillo G, Ikeler K, Orazi J, Abdel-Rahman E, et al. Symptom prioritization among adults receiving in-center hemodialysis: a mixed methods study. Clin J Am Soc Nephrol. 2018;13(5):735–45.

    Article  PubMed  PubMed Central  Google Scholar 

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Borzych-Duz.ałka, D., Harvey, E. (2021). Non-infectious Complications of Hemodialysis in Children. In: Warady, B.A., Alexander, S.R., Schaefer, F. (eds) Pediatric Dialysis. Springer, Cham. https://doi.org/10.1007/978-3-030-66861-7_25

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