Urological Health Chronic Kidney Disease 5 Complications of Hemodialysis Causes, symptoms, and essential prevention tips By Veeraish Chauhan, MD Veeraish Chauhan, MD Facebook LinkedIn Twitter Veeraish Chauhan, MD, FACP, FASN, is a board-certified nephrologist who treats patients with kidney diseases and related conditions. Learn about our editorial process Updated on August 24, 2020 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Kashif J. Piracha, MD Medically reviewed by Kashif J. Piracha, MD LinkedIn Kashif J. Piracha, MD, is a board-certified physician with over 14 years of experience treating patients in acute care hospitals and rehabilitation facilities. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Overview Hypotension Electrolyte Abnormalities Infection Fluid Overload Dialysis Disequilibrium Syndrome Hemodialysis is a life-saving intervention when the kidneys are no longer functioning—but one that can cause significant side effects and complications. Many of the problems are related to the creation of dialysis access, through which blood is removed from the body and cleaned in a dialysis machine. Other complications are caused by the imbalance of fluids and electrolytes in the body and the impact this has on blood pressure and heart function. Science Photo Library / Brand X Pictures / Getty Images Preventing complications of hemodialysis requires careful management on the part of your nephrologist (kidney specialist), the dialysis team, and you as the patient. Knowing the causes and symptoms can ensure that treatment is delivered quickly if a complication occurs, further extending your life, health, and well-being. Overview Hemodialysis is the most common form of dialysis in the United States. It involves removing blood from an access point in a vein, then cleaning the blood of toxins and excess fluids before returning it to the body. Hemodialysis is meant to replicate the function of the kidneys, but it is an inexact science. If the speed of the procedure is too aggressive, or the individual being treated doesn't adhere to the proper dietary or fluid restrictions, the homeostasis (balance) of the body chemistry can be thrown off, causing side effects and complications. The creation of an artificial access point in the body also poses a risk in that the closed vascular system is now open. Infection is the most common concern, but not the only one. Here are just a few of the complications that a nephrologist will watch out for (and try to prevent) if you are on hemodialysis. Hypotension Hypotension is the medical term used to describe low blood pressure. This is a common occurrence during hemodialysis in which the dose and speed of the procedure can cause the too-rapid removal of fluids from the blood. By doing so, the internal pressure in the blood vessels will invariably drop, sometimes precipitously. This can cause symptoms such as: Abdominal discomfortYawning or sighingNauseaVomitingMuscle crampsRestlessnessAnxietyDizziness or faintingClammy skinBlurred vision A severe drop in blood pressure also increases the risk of blood clots. If left untreated, the formation of clots may require additional surgery to repair the access point and, in some cases, lead to stroke, seizures, and heart damage. Adhering to the recommended fluid restrictions can help. By limiting your fluid intake, the amount being extracted during dialysis will be decreased, and any drop in blood pressure will be minimized. Electrolyte Abnormalities Hemodialysis not only removes toxins and excess fluid from the body, but also many of the electrolytes that the body needs to function. In most cases, this won't pose a concern if you adhere to the proper diet. However, if you have diabetes or take angiotensin-receptor blockers (ARBs), even adherence to the diet may not be enough to prevent a condition known as hypokalemia. Hypokalemia Hypokalemia is abnormally low potassium in the blood. Potassium is one of the most important electrolytes that the body uses to regulate fluid balance, muscle contractions, and nerve signals. When potassium levels drop excessively, it can affect all of these functions, causing: FatigueWeaknessConstipationMuscle crampingHeart palpitations If hypokalemia is extreme—defined as levels below 2.5 millimoles per liter (mmol/l)—it can cause potentially serious complications including the breakdown of muscle tissue, ileus (lazy bowels), cardiac arrhythmia (irregular heart rate), respiratory failure, paralysis, and atrial or ventricular fibrillation. For most people, the risk of hypokalemia is low if they follow the prescribed diet and treatment plan. Even those at increased risk are unlikely to experience anything more than mild hypokalemia if they do. Infection Infection is an omnipresent risk in people undergoing hemodialysis. The creation of dialysis access provides bacteria and other microorganisms the opportunity to enter the bloodstream. If an infection were to occur, symptoms would typically include: Local swelling, redness, warmth, and painFlatulence (the accumulation of pus beneath the skin)Fever and/or chills Antibiotics are typically used to treat the infection. Heparin, a type of blood thinner, may be used to prevent blood clots and limb ischemia. Maintaining optimal hygiene and sanitary practices can significantly reduce the risk of infection. It is important to avoid bumping or knocking the dialysis access, since doing so can cause bleeding, especially if the graft or fistula is new. Bleeding increases the risk of infection, anemia, and vascular aneurysm (bulging of the arterial wall). Fluid Overload Fluid overload, also known as hypervolemia, occurs when the kidneys are no longer able to remove enough fluid from the body. If the dialysis machine is not calibrated correctly, hypervolemia may persist despite treatment. Symptoms of hypervolemia include: HeadacheAbdominal cramping and bloatingShortness of breathSwelling of the feet, ankles, wrist, and faceHigh blood pressureWeight gain Adhering to fluid restrictions and tracking your fluid intake can significantly reduce the risk of hypervolemia. If overload persists despite fluid restriction (or develops soon after hemodialysis), let your nephrologist know so that adjustments to your treatment plan can be made. If left untreated, hypervolemia can lead to heart problems, including congestive heart failure, cardiac arrhythmia, and cardiomegaly (enlargement of the heart). Dialysis Disequilibrium Syndrome Dialysis disequilibrium syndrome (DDS) is an uncommon neurological condition that typically affects people who have just started hemodialysis. It is believed to be the body's response to a procedure it considers abnormal, resulting in the release of inflammatory cytokines and other inflammatory chemicals that cause the brain to swell (cerebral edema). Symptoms of DDS include: WeaknessDizzinessNausea and vomitingHeadacheMuscle crampsChanges in behavior or mental status This is usually a short-lasting complication that will resolve as the body adapts to treatment. Intravenous saline is sometimes used to raise blood pressure along with an injection of mannitol (a diuretic) to relieve swelling and pressure around the brain. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 9 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Vadakedath S, Kandi V. 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Fluid overload in hemodialysis patients: a cross-sectional study to determine its association with cardiac biomarkers and nutritional status. BMC Nephrol. 2013;14:266. doi:10.1186/1471-2369-14-266 National Kidney Foundation. Fluid overload in a dialysis patient. Mistry K. Dialysis disequilibrium syndrome prevention and management. Int J Nephrol Renovasc Dis. 2019;12:69-77. doi:10.2147/IJNRD.S165925