الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 71 |  |  |
| | | from | 71 | | |
Abstract
Hemodialysis (HD) is a life-saving intervention that has been used on a regular basis for decades in patients with end stage kidney disease (ESKD) and has been employed in pediatric patients since the 1950s. Despite the fact that HD now is generally a safe therapy, acute intradialytic complications are common, some of which are potentially fatal.
The aim of the study was to detect the incidence of acute intradialytic complications occurring during HD at Alexandria University Children’s Hospital HD unit and study the possible risk factors for the most frequent intradialytic complications and the acute measures applied for treatment of these complications.
This was a prospective cohort study conducted at HD unit of Alexandria University Children’s Hospital over a six-month interval. The study included all children with ESKD and on chronic HD therapy. It was conducted through a checklist fulfilled every dialysis session that included patient’s demographic and medical data, the dialysis session details, intradialytic complications observed during the session and treatments given for these complications.
Thirty-two patients were included in the current study who dialyzed a total of 2678 individual dialysis sessions. All patients had encountered at least more than one intradialytic event during the study period with a total of 513 intradialytic events related to 471 individual dialysis sessions.
In this study, (40.6%) of patients were males while (59.4%) were females. The mean age was 9.16 ± 2.48 years while the mean age at starting dialysis was 7.27 ± 2.33 years. The median number of sessions per week was 3 sessions. Congenital anomalies of the kidney and urinary tract (CAKUT) was the most common original renal pathology (25%) followed by ciliopathy (15.6%). Dilated cardiomyopathy was the most frequent associated medical condition (21.9%) followed by subclinical hypothyroidism (12.5%). Intradialytic hypotension was the most frequently occurring intradialytic complication (71.8%) in this study, followed by intradialytic hypertension (25.7%), muscle cramps (4.7%), intradialytic fever (3%), nausea &vomiting (1.5%), abdominal pain (1.3%) and convulsions (1.1%).
Intradialytic hypotension incidence was significantly associated with higher percentage of ultrafiltration per hour (from body weight) (P =0.033), higher percentage of intradialytic weight loss (P <0.001), longer durations of sessions (P <0.001) and the presence of pre-dialytic hypertension (P <0.001). Meanwhile, intradialytic hypertension was significantly associated with less duration of sessions (P <0.001) and lower percentage of intradialytic weight loss (P <0.001).
Lastly, (74.9%) of cases with intradialytic hypotension responded to stopping ultrafiltration and lowering dialysate temperature, while (25.1%) of didn’t respond to the previous measures and needed further saline infusion. On the other hand, in (66.1%) of cases with intradialytic hypertension, administrating the regular dose of antihypertensive before its timing was enough to reverse the intradialytic hypertension while (19%) necessitated the administration of sublingual Nifedipine (Epilat), and (3.3%) required administration of intravenous antihypertensive medications.