Dialysis Side Effects: What to Expect and How to Manage
Understand the potential side effects of dialysis, how they differ by type, and strategies to reduce discomfort and complications.
Dialysis is a life-saving therapy for those with chronic kidney disease (CKD) or kidney failure. While it allows the body to continue removing waste and excess fluid when the kidneys can no longer do so, it comes with an array of potential side effects. Being aware of these effects — both common and rare — and understanding how to manage them can make the process less daunting and improve quality of life.
What is Dialysis?
Dialysis is a medical procedure designed to filter wastes, excess fluids, and toxins from the blood when the kidneys are unable to perform these essential functions. This is most often required in cases of advanced kidney failure (end-stage renal disease or ESRD), but may also be used in acute situations.
There are two main types of dialysis:
- Hemodialysis: Blood is removed from the body, filtered through a dialysis machine, and then returned.
- Peritoneal Dialysis: The inside lining of the abdomen acts as a natural filter during cycles of fluid exchange.
Main Types of Dialysis and Their Side Effects
| Dialysis Type | Common Side Effects | Less Common Side Effects |
|---|---|---|
| Hemodialysis |
|
|
| Peritoneal Dialysis |
|
|
Common Side Effects of Dialysis
Most people on dialysis encounter some side effects, which can vary in severity and frequency. The nature and likelihood of each effect depend on the dialysis type, treatment duration, and individual health.
Low Blood Pressure (Hypotension)
Low blood pressure is one of the most frequent hemodialysis complications. It occurs when too much fluid is removed too quickly, causing symptoms such as:
- Dizziness or lightheadedness
- Blurry vision
- Nausea
- Fainting
- Cold, clammy skin
Adjusting fluid removal rates and increasing salt intake (if approved by your medical team) may reduce episodes.
Muscle Cramps
Muscle cramps, especially in the legs, may be triggered by changes in fluid volume or blood pressure during dialysis sessions. Stretching, massaging the muscles, and staying hydrated as allowed can provide relief.
Itching (Pruritus)
Many people on dialysis experience skin itching, usually due to buildup of waste products or imbalances in minerals like phosphorus. Moisturizers, prescribed medications, and regular monitoring of mineral levels can help control itching.
Sleep Problems
Insomnia, restless legs syndrome, or overall poor sleep can be a persistent issue. Disrupted sleep may be due to discomfort, changes in routine, or underlying chemical imbalances. Improving sleep hygiene and individual treatment of sleep disorders is often necessary.
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Fatigue and Weakness
Feeling tired, weak, or less energetic is reported by many on long-term dialysis. Causes include anemia (low red blood cells), toxin buildup, or loss of nutrients during treatment. Addressing anemia and ensuring proper nutrition are key strategies.
Anemia
Anemia may develop due to reduced production of erythropoietin (a hormone involved with red blood cell formation) and loss of blood during hemodialysis. Symptoms can include:
- Shortness of breath
- Fatigue
- Pale skin
- Increased heart rate
Treatment often involves iron supplements or erythropoiesis-stimulating agents.
Headaches
Some patients report frequent headaches, which may result from shifts in fluid or blood pressure during or after sessions.
Nausea and Vomiting
These symptoms are common, particularly if there is a rapid removal of fluid or toxin accumulation between dialysis sessions. Notifying your care team if nausea persists is important for effective management.
Fluid Retention and Swelling
Fluid may build up between sessions, leading to swelling (edema) in the legs, feet, hands, or face. Monitoring and limiting dietary sodium and fluids — in consultation with a dietitian — can minimize swelling.
Infections
Infection risks vary based on dialysis type:
- In hemodialysis, infection can occur at the access site or in the blood (bacteremia).
- Peritoneal dialysis increases risk of peritonitis (infection of the lining of the abdomen) or catheter-related infections.
Good hygiene and vigilance for symptoms like redness, swelling, warmth, or pus around the access site are critical to prevent serious complications.
Less Common and Serious Side Effects
While most dialysis complications can be managed, some less frequent side effects may indicate underlying issues or require urgent treatment.
Heart-Related Problems
- Arrhythmia: Irregular heartbeat, which can sometimes be life-threatening.
- Pericarditis: Inflammation of the membrane surrounding the heart, leading to chest pain and fluid buildup.
- Sudden Cardiac Arrest: A rare but critical risk, especially for those with existing heart disease.
Electrolyte Imbalances
- Hyperkalemia: Elevated potassium levels, which can affect heart rhythm and muscle function.
- Other disturbances: Sodium and calcium imbalances may also occur.
Bleeding Disorders
Dialysis increases bleeding risk due to anti-coagulation, needle placement, or platelet dysfunction. Patients should inform providers about unusual bruising or bleeding.
Bone Disease and Amyloidosis
- Renal osteodystrophy (bone weakening) results from imbalanced calcium, phosphate, and vitamin D levels.
- Amyloidosis develops when protein fragments build up in joints and tissues, causing pain and stiffness over the long term.
Hernia and Abdominal Wall Weakness
People on peritoneal dialysis are at higher risk for developing hernias or weakened abdominal muscles due to continuous pressure from fluid exchanges in the abdomen.
High Blood Sugar and Weight Gain (Peritoneal Dialysis)
Because peritoneal dialysis fluid often contains sugar (dextrose), blood glucose may rise, especially in people with diabetes, and weight gain can occur. Your care team may adjust your treatment to limit these effects.
Allergic Reactions and Hypothermia
Rarely, individuals on dialysis may experience allergic reactions to materials used in machines or dialysate, or hypothermia (drop in body temperature) due to prolonged blood exposure outside the body (more common in continuous therapies like CRRT in intensive care).
Mental and Emotional Side Effects
The demands of dialysis, dietary restrictions, and the emotional impact of living with kidney failure can lead to mental health challenges such as:
- Depression
- Anxiety
- Adjustment disorder
Support from healthcare providers, counselors, and peer groups is essential. If mental health symptoms become overwhelming, contacting a professional is advised.
Long-Term Effects of Dialysis
For those who require dialysis for many months or years, longer-term risks include:
- Chronic fatigue
- Persistent muscle weakness
- Frequent infections
- Progressive bone disease
- Complications from iron overload or deficiency (due to medication or transfusions)
Regular monitoring and adapting the dialysis plan can help manage these issues over time.
Managing and Preventing Side Effects
Many side effects can be reduced, managed, or prevented with careful planning and open communication with your care team.
- Report changes: Notify your care team immediately about new or worsening symptoms.
- Follow dietary advice: Work with a registered dietitian to manage fluid, sodium, potassium, and phosphorus intake.
- Maintain proper hygiene: Particularly for access sites and during peritoneal dialysis exchanges.
- Adhere to treatment: Skipping sessions can increase the risk of complications.
- Stay informed: Learn about possible interactions with medicines, supplements, and any other chronic conditions you may have.
When to Call Your Care Team
Certain signs and symptoms should prompt an immediate call to your dialysis or healthcare provider:
- Fever or chills
- Unusual swelling or pain
- Bleeding from the access site
- Shortness of breath
- Confusion or severe headache
- Chest pain or irregular heartbeat
Early intervention can prevent serious complications.
Frequently Asked Questions (FAQs)
Is dialysis painful?
Dialysis itself is usually not painful, although some discomfort may be associated with needle insertion (hemodialysis) or fluid exchange (peritoneal dialysis). Some people experience cramping, headaches, or fatigue during or after treatments.
How long do side effects last?
Some side effects (such as cramps or dizziness) may resolve shortly after sessions end, while others (like itching or fatigue) may persist. With time, your care team can adjust treatments to minimize chronic symptoms.
Can I prevent dialysis side effects?
Not all effects can be prevented, but closely following your care plan, dietary restrictions, and hygiene practices can significantly reduce the risk and severity of complications.
Is it safe to skip dialysis sessions?
No. Missing sessions can quickly lead to dangerous fluid and toxin buildup, increasing the risk of severe symptoms, hospitalization, or death.
Will dialysis side effects go away if I get a kidney transplant?
Most dialysis-related side effects resolve after a successful kidney transplant. However, transplantation comes with its own risks and medication side effects, which your healthcare team will discuss with you.
Who should I contact with concerns about side effects?
Contact your dialysis center or healthcare provider if you have any questions or concerns. For sudden or severe symptoms, seek emergency care immediately.
Takeaway
Dialysis is essential for survival in kidney failure, but it brings a range of side effects. Most can be minimised or managed with proactive communication and care. If you are experiencing symptoms that bother you or interrupt your routine, reach out to your care team for support and solutions. Monitoring your health and following recommended precautions enhance both treatment success and quality of life.
References
- https://www.healthline.com/health/dialysis
- https://www.medicalnewstoday.com/articles/161255
- https://www.medicalnewstoday.com/articles/172179
- https://www.healthline.com/health/video/kidney-failure
- https://hlic.net/what-is-hemodialysis/
- https://www.webmd.com
- https://www.britannica.com/science/dialysis-hemodialysis
- https://www.nhs.uk/conditions/
- https://www.cholainsurance.com/nl/health-insurance/chola-healthline
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