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Background: Haemodialysis (HD) is currently the most common mode of renal replacement therapy (RRT) in the Sub-Saharan Africa. It is however, fraught with many complications which sometimes cause morbidity and mortality outside the primary kidney problems. Hence, there must be concerted effort to identify them early. This would enable the clinician institute preventive measures or treat them efficiently when these adverse effects occur.

Materials and Method: A prospective study was carried out among chronic kidney disease (CKD) and acute kidney injury (AKI) patients in failure assessing HD care at the Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi dialysis center. Subjects were one hundred and twenty six in number: 84 CKD and 42 AKI. Sixty five (65) were males while sixty one (61) were females.  A total of three hundred and sixty nine (369) HD sessions were done. Sociodemographic data and medical history were obtained from each subject and relevant physical examinations and laboratory investigations were carried out prior to and intra dialysis for each subject. Results were analyzed using Statistical Package for Social Sciences (SPSS) software version 17.

Results: Intradialytic complications occurred in 86 out of 126 subjects. The commonest intradialytic complication was hypotension (20.6% for patient-based analysis and 21.1% for session-based analysis). This was followed by hypertension (19.8% for patient-based analysis and 16.5% for session-based analysis). Other complications noted were fever (9.95%), chest pain (9.95%), cramps (1.0%) and seizure (1.0%).

Conclusion: In this study population, intradialysis hypotension was the most common complication followed by intradialysis hypertension. Patients on HD should be assessed and monitored actively to identify and possibly prevent or treat these complications when they occur.

References

  1. Ulasi II, Ijoma CK. The enormity of chronic kidney disease in Nigeria: the situation in a teaching hospital in south-east Nigeria. Journal of Tropical Medicine. 2010; 2010: 1-6.
     Google Scholar
  2. Ulasi II, Ijoma CK, Onodugo OD, Arodiwe EB, Ifebunandu NA, Okoye JU. Towards prevention of chronic kidney disease in Nigeria. Kidney Int Suppl. 2013; (3): 195-201.
     Google Scholar
  3. Davenport A. Intra-dialytic complications during hemodialysis. Hemodial Int. 2006; 10(2): 162-167.
     Google Scholar
  4. Afolabi MO, Abioye-Kuteyi AE, Arogundade FA, Bello IS. Prevalence of chronic kidney disease in a Nigerian family practice population. SA Family Pract. 2009; 51: 132-137.
     Google Scholar
  5. Odubanjo MO, Oluwasola AO, Kadiri S. The epidemiology of end-stage renal disease in Nigeria: the way forward. Int Urol Nephrol. 2011; 43(3): 785-792.
     Google Scholar
  6. Stanifer JW, Jing B, Tolan S, Helmke N, Mukerjee R, Naicker S, et al. The epidemiology of chronic kidney disease in sub-Saharan Africa: A systematic review and meta-analysis. Lancet Glob Health. 2014; 2(3): 174-181.
     Google Scholar
  7. Couser WG, Remuzzi G, Mendis S, Tonelli M. The contribution of chronic kidney disease to the global burden of major non-communicable diseases. Kidney Int. 2011; 80(12): 1258-1270.
     Google Scholar
  8. Fleming GM. Renal replacement therapy review: Past, present and future. Organogenesis. 2011; 7(1): 2-12.
     Google Scholar
  9. Aikpokpo N. Intra-dialytic complications of haemodialysis. FWACP Dissertation. West African College of Physicians; 2013.
     Google Scholar
  10. Laupacis A, Muirhead N, Keown P, Wong C. A disease specific questionnaire for assessing quality of life in patients on hemodialysis. Nephron. 1992; 60: 302-306.
     Google Scholar
  11. Fellner SK. Intradialytic hypertension: Seminars in Dialysis. Willey Online Library; 1993: 371-373.
     Google Scholar
  12. Amira CO, Braimoh RW, Bello BT. Pattern of intradialytic complications at the Lagos university teaching hospital. Afr J. Med Sci. 2012; 41: 411-416.
     Google Scholar
  13. Jha V, Garcia-Garcia G, Iseki K, Li Z, Naicker S, Platner B, et al. Chronic Kidney Disease: global dimension and perspectives. Lancet. 2013; 382(9888): 260-272.
     Google Scholar
  14. Odubanjo M.O, Okolo C.A, Oluwasola A.O, Arije A. End-stage renal disease in Nigeria: An overview of the epidemiology and pathogenetic mechanisms. Saudi J Kidney Dis Transpl. 2011; 22: 1064-1071.
     Google Scholar
  15. Odubanjo M.O, Oluwasola A.O, Kadiri S. The epidemiology of end-stage renal disease in Nigeria: the way forward. Int Urol Nephrol. 2011; 43(3): 785-792.
     Google Scholar
  16. Prabhaka, Rana G S, Shivendia S, Surendra SR, Tauhidul AC. Spectrum of intradialytic complications during hemodialysis and it’s management: a single-center experience. Saudi J Kidney Dis Transpl. 2015; 26(1): 168-172.
     Google Scholar
  17. Ulasi II, Ijoma C, Arodiwe E, Okoye J, Ifebunandu N. Lifestyle risk factors: do they contribute to chronic kidney disease in developing countries?. Internet J Nephrol. 2010; 2010: 1-6.
     Google Scholar
  18. Qui-Li Z, Dietrich R. Prevalence of chronic kidney disease in population-based studies: systematic review. BMC Public Health. 2008; 8: 117.
     Google Scholar
  19. Levey AS, Atkins R, Coresh J, Cohen EP, Collins AJ, Eckardt KU, et al. Chronic kidney disease as a global public health problem: Approaches and initiatives-a position statement from kidney disease improving global outcomes. Kidney Int. 2007; 72: 247-259.
     Google Scholar
  20. Sulowicz W, Radziszewski A. Pathogenesis and treatment of dialysis hypotension. Kidney Int. 2006; 70: 536-539.
     Google Scholar
  21. Clinical Guidelines for Cardiovascular Disease in Dialysis Patients. National Kidney Foundation (NKF)/ Kidney Dialysis Outcome Quality Initiative (KDOQI) Guidelines. 2005 NKF Inc.
     Google Scholar
  22. Inrig JK. Intradialytic hypertension: a less recognized complication of haemodialysis. Am J Kidney Dis. 2010; 55:580-589.
     Google Scholar
  23. Eftimovska-Otovic N, Grozdanovski R, Taneva B, Stojceva-Taneva O. Clinical characteristics of patients with intra-dialytic hypertension. Pirl (Makedown Akad Nauk Umet Odd Med Nauki). 2015; 36(2): 187-193.
     Google Scholar
  24. Mohammad RA, Fatemeh A, Ali AG, Raheb G, Nahid HM, Fatemeh R. Incidence and severity of nausea and vomiting in a group of maintenance hemodialysis patients. J Renal Inj Prev. 2017; 6(1): 49-55.
     Google Scholar
  25. Paweena S, Dinna NC, Jorge C, Maher A, Fahad A, Ioannis K, et al. World incidence of AKI: A meta-analysis. CJASN. 2013; 8(9): 1482-1493.
     Google Scholar
  26. Lazarus MJ. Complications in haemodialysis: an overview. Kidney Int. 2006; 18: 783-795.
     Google Scholar
  27. Gaynes R, Fridman C, Foley MK, Swartz R. Haemodialysis-associated febrile episodes: surveillance before and after major alteration in the water treatment system. Int J Artif Organs. 1990; 13: 482-487.
     Google Scholar
  28. Beck-Sague CM, Jarvis WR, Bland LA, Aruino MA, Aguero SM, Verosic G. Outbreak of gram-negative bacteremia and pyrogenic reactions in a hemodialysis center. Am J Nephrol. 1990; 10: 397-403.
     Google Scholar
  29. Farukawa A, Miyamoto T, Tamura M. Study of factors related to hypotension in hemodialysis patients. Nippon Jinzo Gakka Shi. 1992; 34(4): 417-422.
     Google Scholar
  30. Inrig JK, Oddone EZ, Hasselblad V, Gillespie B, Patel UD, Reddan D, et al. Association of intra-dialytic blood pressure changes with hospitalization and mortality rates in prevalent ESRD patients. Kidney Int. 2007; 71: 454-461.
     Google Scholar
  31. Inrig JK, Patel UD, Toto R, Szczech LA. Association of blood pressure increases during haemodialysis with 2-year mortality in incident hemodialysis patients: A secondary analysis of the dialysis morbidity and mortality wave 2 study. AJKD. 2009; 54(5): 881-890.
     Google Scholar
  32. Robert F. Reilly. Attending rounds: a patient with intra-dialytic hypotension. Clin J Am Soc Nephrol. 2014; 9(4): 798-803.
     Google Scholar
  33. Salako BL, Ajayi SO, Kadiri S, Arije A, Osoba OA. Blood pressure changes in haemodialysis. The Nigerian experience. Nig J Med. 1998; 7(2):14-18.
     Google Scholar