**7.2 Neutropenia**

Neutropenia may be observed in correlation with membrane biocompatibility during hemodialysis. It generally begins within 2-3 min of the start of dialysis and reaches a maximum 10-15 min subsequently (Cheung et al., 1994; Deppisch et al.,1990; Twardowski, 2006). It generally reverts to normal levels after dialysis. Neutropenia observed during hemodialysis is associated with neutrophils accumulating on the hemodialysis membrane surfaces and with sequestration in the lungs in particular (Dodd et al., 1983). C5 and C5ades Arg binding to specific receptors and alterations to various receptors on the neutrophil

Acute Complications of Hemodialysis 279

fell down to 2% in a week owing to the improvements in the dialysis technology (Ahsan et al., 2004). Although cramps are mostly seen in the lower extremities, they can also occur in

Pathogenesis of muscle cramps is not fully clarified, but electromyographic research indicates that they more likely to originate from the neurons rather than the muscle itself (McGee, 1990). Subnormal muscle metabolism is considered as the most important factor in cramp etiology (Chang et al., 2002). For this reason, hypotension, changes in plasma osmolarity, hyponatremia, carnitine deficiency, hypomagnesemia and tissue hypoxia are thought to cause development of cramps (Ahsan et al., 2004; Chou et al., 1985; Khajehdehi et al., 2001). In these aforesaid situations, the muscle metabolism is impaired and cramps develop. Muscle cramps may lead to early finishing of dialysis sessions, failure to carry out

Hypertonic glucose, saline and mannitol may be administered in the acute treatment of cramps (Canzanello et al., 1991). Non-medical measures that can be taken to prevent cramps include avoidance of intradialytic hypotension and osmolarity changes, and regular exercise. There are studies showing that administration of 320 mg quinine sulfate 1 or 2 hours before hemodialysis therapy decreased muscle cramps **(**Kaji et al**.,** 1976; Roca et al., 1992). However, use of quinine sulfate has side-effects such as cinchonism, optical atrophy, thrombocytopenia, arrhythmia, hemolytic uremic syndrome and interaction with drugs such as digoxin and warfarin (Wolf et al., 1992; Goldenberg&Wexler, 1988; Kojouri et al., 2001; Pedersen et al., 1985). There are also studies showing that muscle cramp development is reduced by administering 400 mg/day vitamin E, 250 mg/day vitamin C (Khajehdehi et al., 2001), 12 gm of creatinin monohydrate before dialysis (Chang et al.,2002), prozosin (0.25- 1 mg) (Sidhom et al., 1994) and L-carnitine (Bellinghieri et al., 1983). However, the safety of

using vitamin C above 200 mg for a long time is not proven (Kobrin et al., 2007).

kinked hemodialysis blood lines. *Hemodial Int,* 11, 1, 38-41

lessons and future opportunities. *Kidney Int,* 67, 1, 1-13

perspective. *Semin Dial,.* 20,1,53-62.

Abbott, K.C., Neff, R.T., Bohen, E.M. & Narayan, R. (2007). Anticoagulation for chronic atrial

Abe, S., Yoshizawa, M., Nakanishi, N., Yazawa, T., Yokota, K., Honda, M. & Sloman, G.

Abtahi, M., Uzan, M. & Souid, M. (2007). Hemolysis-induced acute pancreatitis secondary to

Acker, C.G., Johnson, J.P., Palevsky, P.M. & Greenberg, A. (1998). Hyperkalemia in

Agarwal, R. (2005). Hypertension and survival in chronic hemodialysis patients--past

Agarwal, A.K., Patel, B.M. & Haddad NJ. (2007). Central vein stenosis: a nephrologist's

Ahmed, J., Besarab, A., Lubkowski, T. & Frinak, S. (2004). Effect of differing blood lines on delivered blood flow during hemodialysis. *Am J Kidney Dis,* 44,3,498-508

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sufficient ultrafiltration and finally dialysis inefficiency.

surface are held responsible in the pathogenesis of dialysis-induced neutropenia. In addition, several studies have shown a correlation between complement activation and leukopenia. (Hakim et al., 1984; Huang et al., 2009; Lee et al., 1984; Takemoto et al., 2011) Temporary neutropenia does not generally lead to significant clinical problems. However, it is regarded as maybe one of the factors causing a predisposition to infection observed in hemodialysis patients.
