**12. References**


kidney disease score in the HBS group, while there was a decrease in the control group (*P*=0.004). There was no other significant variation in quality-of-life items during the study. In another randomised trial comparing 6-month HD vs HBS treatment, a validated dialysis-related symptoms questionnaire was used to assess dialysis-related quality of life (Neshrallah et al., 2008). This questionnaire asked patients to rate the frequency and severity of dizziness, fatigue, muscle cramps, and other symptoms. None of these differed

The growing number of patients with CKD/KDOQI stage 5D is characterised by higher age and increasing comorbidities such as arterial hypertension, diabetes mellitus, arteriosclerosis and atherosclerosis, coronary heart disease as well as peripheral arterial perfusion impairments. In the large majority of patients, age and morbidity-related vascular alterations result in a reduced refilling capacity from the extracellular and intracellular

The divergence between ultrafiltration and absent refilling can lead to severe hypotensive events during the course of the dialysis. Incidence and intensity of hypotensive complications are correlated with morbidity, frequency of hospitalisation, myocardial and

The complications are preventable by increasing the dialysis time and frequency, decreasing the dialysate temperature, increasing the dialysate calcium concentration and/or with online hemodiafiltration. Nonetheless, dialysis time and frequency are finite, and affects the staff and unit workload, while elevated dialysate calcium concentrations could lead to positive mass balance with cumulative calcium overload exposing the patients to higher risk of valvolar and vascular calcification. Nevertheless, hemodiafiltration, due to the high efficiency and high solute extraction, can yield to transient electrolyte and osmolar disequilibrium (Ursino et al, 1997) opposing to plasma refilling and exposing to higher risk of electrical disequilibrium and cardiac dysrhythmias especially in fragile patients, Then, HBS lends itself as a gentle and effective procedure to improve the refilling capacity, to prevent hypotensive events and to optimize the post-dialysis weight. Under HBS, arterial hypertension was improved, dialysis therapy more effective, the body weight optimised, the myocardial function improved, the risk of intradialytic hypotension lower and the patients'

Azar T A, Biofeedback systems and adaptive control hemodialysis treatment, Saudi J

Basile C, Giordano R, Vernaglione L et al. Efficacy and safety of haemodialysis treatment

Bégin V, Déziel C, Madore F. Biofeedback regulation of ultrafiltration and dialysate

with the Hemocontrol™ biofeedback system: a prospective medium-term study.

conductivity for the prevention of hypotension during hemodialysis. ASAIO

significantly between groups over time.

compartment into the intravasal compartment.

cerebral ischemia and consecutively with mortality.

quality of life during intradialytic and interdialytic intervals improved.

HBS is a treatment option for elderly, morbid dialysis patients.

Kidney Dis Trasplant, 2008, 19, 6, 895-903.

Nephrol Dial Transplant 2001; 16: 328-334.

Journal 2002; 48: 312-315.

**11. Conclusions** 

**12. References** 


**16** 

*Turkey*

**Acute Complications of Hemodialysis** 

*Karadeniz Technical University, School of Medicine, Department of Nephrology* 

Chronic kidney disease (CKD) is a common public health problem, which occurs in many countries with an increasing prevalence. Over 50 million people throughout the world are known to have CKD, and of these, more than 1 million require renal replacement therapies such as dialysis and renal transplantation. In recent years , the rising incidence of diabetes and hypertension, the most common two causes of CKD, cause an increase in

Hemodialysis, which is one of the renal replacement therapies, is a life-saving treatment. In the absence of this therapy, more than a million patients worldwide would have died within weeks. Hemodialysis was successfully performed for the first time in 1944 by Willem Kollf in patients with renal failure. However, hemodialysis is accompanied by several complications. During the first years following the introduction of hemodialysis, complications were common due to the technical drawbacks associated with the dialysis machines and water systems. Currently, the advances in technology, particularly those in the last 20 years, have reduced the complications. However, complications caused by the reasons other than the dialysis machine and water system remain as a significant cause of

Cardiovascular complications are currently the most common complication of hemodialysis. Among these complications, the rate of symptomatic intradialytic hypotension ranges between 20% and 50%, and it remains an important problem (Cruz DN et al., 1997). Another concern is the hemodialysis-associated arrhythmias, the rate of which was reported to be 5% to 75%. The common and lethal types of arrhythmias include ventricular arrhythmias and ectopies. The rate of hemodialysis-associated complex ventricular arrhythmia is around 35% (Burton JO et al., 2008). The second most common type of arrhythmia is the atrial fibrillation, the rate of which is 27% (Genovesi S et al., 2008). Sudden cardiac death accounts for 62% of cardiac-related deaths and it is usually attributed to arrhythmias (Herzog CA et al., 2008). The first year of hemodialysis is of vital importance with respect to sudden cardiac deaths, which was determined in 93 of 1000 patients in the first year of hemodialysis (Shastri

While cramps were observed in 24%-86% of the cases during the first years following the introduction of dialysis therapy, recently it has been shown that only 2% of the patients having ≥2 hemodialysis sessions in a week suffer from cramps (Kobrin SM et al., 2007). Other common complications include nausea, vomiting with a rate of 5%-15%, headache with a rate of 5%-10% and itching with a rate of 5%-10%( Jesus AC et al., 2009; Mettang T et al., 2002)**.** Although cramps, nausea-vomiting, headache and itching do not result in mortality, they substantially deteriorate the quality of life of the patients. Although more

**1. Introduction** 

the prevalence of CKD**.** 

S et al., 2010).

morbidity and mortality in hemodialysis patients.

Gülsüm Özkan and Şükrü Ulusoy

