5 Complications of Hemodialysis

Causes, symptoms, and essential prevention tips

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Hemodialysis 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.

Patient usIng dialysis machine
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.

This article discusses some of the complications of hemodialysis and how you can recognize them.


Hemodialysis requires the creation of an artificial access point in the body. This poses a risk in that the closed vascular system is now open.

Infection is a continual risk in people undergoing hemodialysis. This is because the access point 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 pain
  • 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).


Hypotension, or low blood pressure, is a common occurrence during hemodialysis. The dose and speed of the procedure can cause the too-rapid removal of fluids from the blood. When this happens, the internal pressure in the blood vessels will invariably drop, sometimes steeply. This can cause symptoms such as:

  • Abdominal discomfort
  • Yawning or sighing
  • Nausea
  • Vomiting
  • Muscle cramps
  • Restlessness
  • Anxiety
  • Dizziness or fainting
  • Clammy skin
  • Blurred 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 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:

  • Fatigue
  • Weakness
  • Constipation
  • Muscle cramping
  • Heart 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.

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:

  • Headache
  • Abdominal cramping and bloating
  • Shortness of breath
  • Swelling of the feet, ankles, wrist, and face
  • High blood pressure
  • Weight 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:

  • Weakness
  • Dizziness
  • Nausea and vomiting
  • Headache
  • Muscle cramps
  • Changes 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.


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 most common side effect of hemodialysis is infection. Hypotension, electrolyte imbalances, fluid overload, and dialysis disequilibrium syndrome are some of the other complications you may experience when you undergo hemodialysis.

8 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.
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By Veeraish Chauhan, MD
Veeraish Chauhan, MD, FACP, FASN, is a board-certified nephrologist who treats patients with kidney diseases and related conditions.