What are the common complications associated with haemodialysis and how should they be managed in primary care?

Common complications associated with haemodialysis include:

• Symptoms related to uraemia and fluid overload such as breathlessness, fatigue, swelling, and muscle cramps.
• Access-related complications including fistula or graft failure, infection, or thrombosis.
• Cardiovascular symptoms such as dizziness and headaches, potentially related to fluid shifts during dialysis.
• Psychological and behavioural symptoms including anxiety, depression, and mood fluctuations.
• Other symptoms such as itching, poor appetite, nausea, and cognitive impairment.

Management in primary care should focus on:

• Recognising and monitoring symptoms regularly by asking patients about their symptoms and exploring whether these are due to renal disease, dialysis treatment, or other causes.
• Coordinating care with renal specialists to ensure timely interventions, including vascular access monitoring and referral if complications arise.
• Supporting patients with symptom control, including managing fluid balance, dietary advice, and addressing psychological symptoms.
• Providing information and support to patients and carers to help them understand their treatment and complications.
• Ensuring continuity of care and avoiding unnecessary treatment burden by coordinating appointments around dialysis schedules.

Primary care should also be aware of the timing and planning of dialysis access formation and the importance of early referral to specialist services for access creation and management.

Overall, management involves symptom recognition, supportive care, coordination with specialist renal teams, and patient education to improve quality of life and reduce complications.

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