Dialysis side effects: What patients need to know about complications and kidney health

Dialysis is a critical treatment for individuals with kidney failure, helping to filter waste, excess fluids, and toxins from the blood when the kidneys lose their function. While dialysis significantly extends life expectancy and improves quality of life, it is accompanied by a range of side effects and complications. According to a comprehensive review published in Cureus (2017) and detailed findings from the National Kidney Foundation, patients undergoing dialysis face numerous challenges that impact their physical and emotional well-being. Understanding these side effects helps patients and caregivers better manage symptoms and improve treatment outcomes. This article explores the common side effects of dialysis, their causes, and strategies to alleviate their impact.Low blood pressure is one of the most common and immediate side effects during hemodialysis, affecting approximately 20-30% of treatments. The rapid removal of excess fluids can lead to a drop in blood volume, causing dizziness, nausea, weakness, and sometimes fainting episodes. This occurs because the body struggles to adjust to the sudden changes in fluid balance. To manage this, healthcare providers may slow the dialysis process, reduce the amount of fluid removed at a time, or give intravenous fluids to stabilize blood pressure. Patients are also advised to avoid excessive fluid intake between sessions to reduce the risk.Muscle cramps during or after dialysis are painful and debilitating for many patients. These cramps typically result from shifts in body fluid levels and electrolytes like sodium, potassium, and calcium. The sudden changes can contract muscles involuntarily. Patients are encouraged to stretch and massage affected muscles, and in some cases, dialysis staff may administer saline solutions to ease cramps. Research suggests that maintaining stable fluid and electrolyte levels through diet and optimized dialysis schedules can reduce the incidence and severity of cramps.Itchy skin is a common and frustrating issue for many people on dialysis, caused by waste product buildup that dialysis cannot fully remove. The itching often affects the legs and can be severe enough to disturb sleep and daily comfort. Managing this symptom involves moisturizing the skin, using antihistamines or specialised lotions, and optimising dialysis to remove as many toxins as possible. Emerging treatments include therapies targeting receptors involved in itching processes.Persistent fatigue is a widespread complaint among dialysis patients and can significantly decrease quality of life. This tiredness arises both from the dialysis process—which places physical stress on the body—and from associated anaemia caused by reduced red blood cell production. Fatigue can also be worsened by poor sleep, nutritional deficiencies, and fluid imbalances. Proper management includes treating anaemia with medications, maintaining a balanced diet, and regular physical activity recommended by healthcare providers to boost overall energy levels.Dialysis requires access to the bloodstream via catheters, fistulas, or grafts, creating potential entry points for bacteria. This elevates the risk of infections, ranging from local infections at the site to serious bloodstream infections (sepsis) that require urgent treatment. Patients are trained in proper hygiene and monitoring for signs of infection such as redness, swelling, or fever. The National Kidney Foundation highlights that strict infection control practices in dialysis centres are essential to minimising these risks.Cardiovascular disease is the leading cause of death among dialysis patients. Dialysis and kidney disease contribute to chronic inflammation, electrolyte imbalances, and high blood pressure, which strain the heart and blood vessels. Patients commonly develop heart rhythm disorders, heart failure, and arterial stiffness. Prevention includes tight control of blood pressure, managing cholesterol levels, and minimising fluid overload. Regular cardiovascular assessments are recommended for early detection and treatment.Maintaining balance in potassium, calcium, phosphorus, and other electrolytes is a constant challenge during dialysis. Fluctuations can lead to muscle weakness, irregular heartbeat, or dangerous cardiac events. Dialysis protocols are carefully designed to remove excess electrolytes while preserving necessary amounts. Patients need to monitor their dietary intake of these minerals and follow healthcare providers’ guidance to maintain safe levels.Kidney failure disrupts the regulation of calcium and phosphorus, often resulting in weakened bones, bone pain, and fractures. Dialysis patients may develop renal osteodystrophy, a condition caused by mineral imbalances and hormone irregularities. Treatment may include phosphate binders, vitamin D supplements, and dietary modifications to support bone health.Dialysis can interfere with thyroid hormone levels, particularly by lowering triiodothyronine (T3), an active hormone important for metabolism and energy. This imbalance can cause fatigue, cold sensitivity, and worsen cardiovascular health. Monitoring thyroid function and appropriate treatment can help reduce these symptoms.Proper fluid balance is vital for dialysis patients. Drinking too much fluid between sessions can cause swelling, high blood pressure, and breathing difficulties, while removing too much fluid too quickly during dialysis can lead to cramps, low blood pressure, and cardiac stress. Patients need to carefully manage fluid intake and follow their dialysis program to maintain this delicate balance.Dialysis can take a toll on mental health, with many patients experiencing anxiety, depression, and memory difficulties. The chronic nature of kidney failure and the demands of dialysis contribute to emotional strain. Comprehensive care includes mental health support, counselling, and community resources to enhance coping and quality of life.Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before making any changes to your health routine or treatment.