[Complications of treatment by dialysis]

Abstract

Only 30 years ago, the inevitable short-term outcome in patients with end-stage renal disease was death. Today, the widespread development of dialysis-transplantation programs and extended indications have totally revolutionalized the situation, yet despite great progress, quality of life and life expectancy remain inferior in uremic patients. Cardiovascular disease is the main cause of mortality, 50% of all deaths in chronic dialysis patients resulting from complex mechanisms leading to left ventricular hypertrophy, coronary artery disease and atheroma of the great vessels. A large number of factors are involved in disease progression including age, genetic factors and personal health status prior to dialysis as well as the nature of the initial renal disease and dialysis-related metabolic and cardiac output disorders among others. Morbidity is also higher in dialysis patients, mainly due to altered blood volume and pressure which respond variably to treatment. Other conditions include rythm disorders, diabetes, potassium depletion, hypoxemia. Angina is frequent and ischemia can occur in several territories, including the mesentery as reported by Hachache et of in this issue of La Presse Médicale. Prognosis depends heavily on events which occur prior to dialysis and thus on close collaboration between the nephrology team, the family physician and other specialists who must coordinate their efforts to identify early curable renal diseases and correctly manage moderate disease to prevent progression and avoid emergency dialysis situations.