Preventive Strategies for Major Complications in Maintenance Hemodialysis

Abstract

Patients undergoing maintenance hemodialysis are at high risk of complications, including intradialytic hypotension, vascular access infection, anemia instability, and cardiovascular events. These complications significantly contribute to morbidity, hospitalization, and mortality. Preventive and structured management strategies are essential to improve clinical outcomes. This study was conducted as a systematic review following PRISMA 2020 guidelines. A comprehensive search was performed in PubMed, Scopus, and Google Scholar for studies published between 2023 and 2025. Eligible studies included randomized controlled trials and observational studies involving adult hemodialysis patients and evaluating preventive interventions for major dialysis-related complications. After screening 1,086 records and assessing 81 full-text articles, 12 studies met the inclusion criteria and were included in the qualitative synthesis. The included studies demonstrated that protocol-based and preventive interventions significantly reduced complication rates. Individualized ultrafiltration adjustment, cool dialysate application, and biofeedback systems reduced intradialytic hypotension. Vascular access care bundles lowered infection rates. Algorithm-based anemia management improved hemoglobin stability, while structured fluid management and cardiovascular screening reduced hospitalization and adverse events. Structured, nursing-driven, and preventive strategies effectively reduce major complications in maintenance hemodialysis. Implementing standardized monitoring protocols and multidisciplinary approaches may enhance patient safety and clinical outcomes