What are the complications of RRT?

Access Related
  • Failure to obtain access
  • Damage to vessels and surrounding structures
    • Risk of venous stenosis
    Pneumothorax / haemothorax
  • Haemorrhage
  • Infection
  • Air Embolism
  • Pain
Anticoagulation Related
  • Bleeding
  • Heparin induced thrombocytopenia
  • Hypocalcaemia with citrate
Filtration Related
  • Hypotension and haemodynamic instability:
    • Common on initiation of renal replacement as the circuit often takes 200-300 ml of blood
    • Usually responds to a fluid bolus
    Anaemia (up to 300ml of blood can be lost in clotted filter)
  • Removal of solutes:
    • Electrolyte imbalance
    • Trace elements and amino acids
    • Therapeutic drugs
    Hypothermia
  • Metabolic abnormalities
  • Reaction to filter membrane and anaphylaxis
  • Rising lactate:
    • Inability to metabolise lactate in the filter fluid to bicarbonate
    • Switch to filter fluid with bicarbonate buffer
    Immobility