Management of Thrombocytopenia and Behavioral Changes in Hemodialysis Patients

Assessment and Diagnosis

Behavioral changes in hemodialysis patients may be related to depression, anxiety, or hostility, which are common in dialysis patients, according to the American Journal of Kidney Diseases 1, 2
Physiological changes associated with dialysis, including impaired platelet functioning, hypercortisolemia, and increased catecholamines, can contribute to behavioral changes, as noted by the American Journal of Kidney Diseases 1
Inadequate dialysis and anemia control can also lead to behavioral changes in hemodialysis patients, as reported by the American Journal of Kidney Diseases 2

The American Journal of Kidney Diseases recommends optimizing dialysis adequacy and anemia control to improve overall well-being in hemodialysis patients 2
For patients with depressive or anxiety symptoms, the Kidney International suggests starting with non-pharmacological interventions such as cognitive behavioral therapy, social or peer support, and exercise 4
The American Journal of Kidney Diseases advises considering selective serotonin reuptake inhibitors (SSRIs) or atypical antidepressants for patients with persistent symptoms, while exercising caution due to potential gastrointestinal side effects 2

A multidisciplinary team, including nephrologists, mental health professionals, and social workers, should be involved in the management of hemodialysis patients, as recommended by the American Journal of Kidney Diseases and Praxis Medical Insights 3, 5
The American Journal of Kidney Diseases suggests that masters-prepared social workers should perform psychological assessments when patients begin dialysis and reassess stable patients every six months 5
There is an association between depression and impaired platelet functioning, which should be considered when managing thrombocytopenia and behavioral changes in hemodialysis patients, as noted by the American Journal of Kidney Diseases 1

Patients with autonomic dysfunction, such as diabetics, are at higher risk for intradialytic hypotension, which may contribute to both thrombocytopenia and behavioral changes, according to the American Journal of Kidney Diseases 6
Modifying dialysis parameters, such as lowering dialysate temperature or maintaining dialysate calcium at 3 mEq/L, may be beneficial for patients with persistent symptoms, as suggested by the American Journal of Kidney Diseases 6, 7