As to the dialysis, it is a common site in kerala, I cannot vouch for other states, the centres for dialysis are mushrooming in not only urban areas but also in semi urban and rural areas. Needless to say that these centres are not attached to a regular hospital where facilities are available to deal with any emergencies that may occur to patients on dialysis. Most important point I want to make in this connection is that intradialysis deaths are not uncommon and when they do occur it is presumed that such deaths are inevitable and they don’t make news. Patients relatives think that patients died due to chronic renal failure and nothing could have saved these patients. And they are ignorant that these had happened as common complications occurring during dialysis procedure. if these centres are attached to a regular hospital where ICU facilities are available, these patients may have been saved if attended to immediately without wasting time.
It is well recognized that the procedure of hemodialysis is associated with significant changes in blood pressure and systemic hemodynamics; 20-30% of treatments are complicated by intradialytic hypotension (IDH). There are now an increasing number of studies using electrocardiographic, isotopic and echocardiographic techniques that show that subclinical myocardial ischemia occurs during dialysis. This concept is supported by some studies showing that dialysis can induce acute rises in troponins and creatinine kinase MB. . Cardiovascular death is the biggest single cause of mortality in dialysis patients and of this sudden death comprises the largest proportion. As such, there is a large body of evidence examining whether dialysis is pro-arrhythmogenic. It is clear that dialysis can increase QTc interval and QT dispersion and is capable of inducing arrhythmias on Holter monitoring, likely due to the interaction of multiple factors, some of which prime for the development of arrhythmias (particularly the presence of preexisting cardiac disease), and some of which act as triggers .
It is being learnt now that compared with standard thrice-weekly hemodialysis, more frequent HD regimes are associated both with significant reductions in UF(Ultrafiltration) volume and rate and with abrogation of intradialytic hypotension. Furthermore, it is apparent that modification of these factors is associated with significant reductions in the occurrence of dialysis-induced myocardial stunning. More-frequent home-based therapies are associated with lower levels of markers for inflammation, myocardial cellular damage, and congestion. All of the above factors have been previously described as influencing survival in chronic HD patients.
https://www.ncbi.nlm.nih.gov/pubmed/17555488https://www.ncbi.nlm.nih.gov/pubmed/19516249UA Mohammed