Technical and Clinical Complications of Intermittent Hemodialysis in the Intensive Care Unit

Abstract Acute kidney injury (AKI) requiring renal replacement therapy (RRT) in the intensive care unit (ICU) is a serious condition with high mortality. Although intermittent hemodialysis (IHD) and sustained low-efficiency dialysis (SLED) are viable alternatives to continuous renal replacement therapy (CRRT) in the management of AKI, these therapeutic modalities engender their own complications. Such complications can be classified generally into two broad categories, technical and clinical. The technical complications relate to vascular access problems, air embolism, hemolysis, and electrolyte and acid-base disorders. For example, a poorly functioning vascular access is a major cause of treatment “down time” in the acute setting. The clinical complications consist of bleeding, thrombosis, hypotension, hypoxemia, bio-incompatibility and allergic reactions, arrhythmias, febrile reactions, and dialysis dysequilibrium syndrome. Other important issues related to dialysis in an acute care setting consist of recovery of renal function, nutrition, and dose of dialysis in AKI. These complications and issues require prompt recognition and management. Although local expertise with the use of IHD/SLED in the management of AKI remains the key factor in determining outcome, prompt recognition and awareness of the above issues enhance such expertise.