Segurança da Hemodiálise: Riscos, Complicações e Monitoramento

Hemodialysis (HD) is life-sustaining but carries procedure-related risks:

Common Complications

• Infection: Catheter > graft > fistula. Bloodstream infection (CRBSI) — major morbidity.
• Hypotension: Ultrafiltration > plasma refill → ↓ preload. 20–30% of sessions. Mitigate: sodium profiling, cool dialysate, midodrine.
• Muscle Cramps: Rapid fluid/electrolyte shifts. Stretch, saline, quinine (off-label).
• Access Complications: Stenosis, thrombosis, aneurysm, steal syndrome.
• Dialysis Disequilibrium Syndrome: Rapid urea clearance → cerebral edema → headache, seizure, confusion. Prevent: lower BUN reduction, longer time, higher dialysate Na⁺.

Chronic Complications

• Anemia: EPO deficiency, blood loss, inflammation → ESA + iron.
• Mineral Bone Disorder: ↑ PTH, ↑ phosphate, ↓ calcitriol → vascular calcification.
• Amyloidosis (β₂-microglobulin): Long-term HD; carpal tunnel, arthropathy.

Safety Systems

Air detectors, blood leak alarms, pressure monitors, conductivity/pH guards, UF controllers.

Patient Role

Adherence to schedule, fluid/sodium restriction, medication compliance, access care (fistula exercise, no BP/IV on access arm).

Multidisciplinary team (nephrology, nursing, dietitian, social work) optimizes safety.