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 January 23, 2023 Medically reviewed by Matthew Wosnitzer, MD Medically reviewed by Matthew Wosnitzer, MD LinkedIn Twitter Matthew Wosnitzer, MD, is board-certified in urology. He is an attending physician at Yale New Haven Health System, Northeast Medical Group and teaches at the Frank Netter School of Medicine. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Infection Hypotension Electrolytes Fluid Overload DDS 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. 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. Infection 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 painThe accumulation of pus beneath the skinFever 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). The Different Types of Vascular Access for Dialysis Hypotension 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 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. Blood Pressure From Hemodialysis Signs and Prevention 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. Low Potassium 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). What Is Hypovolemia? 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. Dialysis Disequilibrium Syndrome Overview Summary 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. Centers for Disease Control and Prevention. Know the signs and symptoms of infection. Morfin JA, Fluck RJ, Weinhandl ED, Kansal S, McCullough PA, Komenda P. Intensive hemodialysis and treatment complications and tolerability. Am J Kidney Dis. 2016;68(5S1):S43-S50. doi:10.1053/j.ajkd.2016.05.021 National Heart, Lung, and Blood Institute. Low blood pressure. Guttee V, Nie YX, Wang YM, Ding XQ. Impact of abnormal serum electrolyte levels and acid-base disorders on clinical outcomes among maintenance hemodialysis patients. Open Access Libr J. 2017;4:e3623. doi:0.4236/oalib.1103623 Elliott TL, Braun M. Electrolytes: potassium disorders. FP Essent. 2017;459:21-28. Antlanger M, Hecking M, Haidinger M, et al. 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 By Veeraish Chauhan, MD Veeraish Chauhan, MD, FACP, FASN, is a board-certified nephrologist who treats patients with kidney diseases and related conditions. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! 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