Spectrum of Intradialytic Complications in End-Stage Renal Disease Patients on Maintenance Hemodialysis

Background: End-stage renal disease (ESRD) is a growing public health challenge in low- and middle-income countries, including Pakistan, where hemodialysis remains the predominant renal replacement therapy. Although lifesaving, hemodialysis is frequently associated with intradialytic complications that impair treatment safety and outcomes. Objective: To determine the frequency and spectrum of intradialytic complications in ESRD patients undergoing maintenance hemodialysis and to identify demographic and clinical factors associated with their occurrence. Methods: A cross-sectional study was conducted at Khyber Teaching Hospital, Peshawar, between October 2024 and March 2025. Eighty-two patients aged 18–70 years on maintenance hemodialysis for at least three months were recruited by consecutive sampling. Data were collected on demographics, comorbidities, vascular access, and laboratory parameters. Complications were defined using standardized criteria. Statistical analyses included chi-square, Fisher’s exact, and t-tests, with p ≤ 0.05 considered significant. Results: Ninety-three complication events were observed among 82 patients. Hypotension (29.3%) was most common, followed by hypertension (17.1%), back pain (14.6%), and nausea/vomiting (12.2%). Less frequent events included infections (8.5%), cramps (8.5%), and chest pain (7.3%). Female patients (p = 0.0046) and those with dialysis vintage ≥2 years (p < 0.001) had significantly higher complication rates, while age, vascular access, dialysis frequency, and session length showed no significant associations. Conclusion: Intradialytic complications are frequent among ESRD patients, with hypotension the most prevalent. Female sex and longer dialysis duration independently increased risk, underscoring the need for targeted preventive strategies to improve hemodialysis safety.