From the Guidelines
Uremia can cause a wide range of serious complications throughout the body, including neurological, cardiovascular, gastrointestinal, hematologic, metabolic, and dermatological manifestations, as well as respiratory and immune system complications, as noted in a study published in the International Journal of Oral Science 1. When kidneys fail to remove waste products from the blood, these toxins accumulate and affect multiple organ systems.
Common Complications of Uremia
- Neurological symptoms: confusion, seizures, and coma
- Cardiovascular problems: hypertension, pericarditis, and heart failure
- Gastrointestinal issues: nausea, vomiting, and bleeding
- Hematologic abnormalities: anemia and bleeding disorders
- Metabolic disturbances: acidosis and electrolyte imbalances
- Dermatological manifestations: severe itching and yellow-gray skin discoloration
- Respiratory complications: pulmonary edema and pleuritis
- Immune system compromise: increased infection risk
- Hormonal imbalances: sexual dysfunction and menstrual irregularities These complications occur because uremic toxins interfere with normal cellular function throughout the body, causing inflammation, oxidative stress, and disruption of normal physiological processes, as discussed in the American Journal of Kidney Diseases 1.
Treatment and Management
Treatment focuses on addressing the underlying kidney dysfunction through dialysis or transplantation while managing specific symptoms with medications and supportive care.
- Dialysis or transplantation to address underlying kidney dysfunction
- Medications to manage specific symptoms
- Supportive care to improve quality of life It is essential to note that the decision to initiate dialysis therapy remains a decision informed by clinical art, as well as by science, and the constraints of regulation and reimbursement, as stated in the American Journal of Kidney Diseases 1. For some patients, conservative therapy without dialysis or transplantation is the appropriate option, and the healthcare team should strive to maximize quality of life and length of life by using dietary and pharmacological therapy to minimize uremic symptoms and maintain volume homeostasis, as recommended in the American Journal of Kidney Diseases 1.
From the Research
Complications of Uremia (Azotemia)
The complications of uremia (azotemia) can be acute or chronic, and they affect multiple organ systems. Some of the complications include:
- Gastrointestinal symptoms, pericarditis, pleuritis, and central nervous system alterations, which can end with coma 2
- Systemic microinflammation, cardiovascular disease, immunodeficiency, malnutrition, anemia, bone metabolism, and polyneuropathy 2
- Fluid and electrolyte imbalances, such as hypervolemia, hyperkalemia, hyperphosphatemia, hypocalcemia, and bicarbonate deficiency (metabolic acidosis) 3
- Oxidative stress induced by uremic toxins, which can lead to cardiovascular diseases and increased risk of mortality in patients with CKD 4
Organ System Damage
Chronic uremia can result in damage to multiple organ systems, including:
- Cardiovascular system: increased risk of developing cardiovascular disease (CVD) due to the accumulation of uremic toxins 5
- Nervous system: polyneuropathy and central nervous system alterations 2
- Bone metabolism: altered bone metabolism due to the accumulation of uremic toxins 2
- Immune system: immunodeficiency due to the accumulation of uremic toxins 2
Therapeutic Options
There are few therapeutic options available to manage the complications of uremia, including: