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Risks
By Mayo Clinic staffMost people who require dialysis face a variety of serious health problems. Hemodialysis prolongs life for many people, but life expectancy for people who need dialysis is still much lower than for the general population.
Complications can stem from hemodialysis or the underlying kidney disease.
- Low blood pressure (hypotension). A drop in blood pressure is the most common side effect of hemodialysis, particularly if you have diabetes. Low blood pressure may be accompanied by shortness of breath, abdominal cramps, muscle cramps, nausea or vomiting.
- Muscle cramps. Although doctors don't know for sure what causes muscle cramps during dialysis, they are common. Sometimes the cramps can be eased by changing the frequency and intensity of dialysis.
- Itching. Many people who undergo dialysis have itchy skin, which is often worse during or just after the procedure.
- Sleep problems. People on dialysis often have trouble sleeping, sometimes because of breaks in breathing during sleep (sleep apnea) or because of aching, uncomfortable or restless legs.
- Anemia. Anemia — not having enough red blood cells in your bloodstream — is a common complication of kidney failure and of hemodialysis. Failing kidneys reduce their production of a hormone called erythropoietin, which stimulates formation of red blood cells. Diet restrictions, poor absorption of iron, or removal of iron and vitamins by dialysis also can contribute to anemia. Blood loss from dialysis or routine blood sampling can have the same effect.
- Bone diseases. If your damaged kidneys are no longer able to use vitamin D to absorb calcium, your bones may weaken. Overproduction of parathyroid hormone — a common complication of kidney failure — can strip calcium from your bones.
- High blood pressure (hypertension). High blood pressure is a leading cause of kidney failure. If you eat too much salt or drink too much fluid while being treated for kidney failure, your high blood pressure may get worse — which takes a toll on your remaining kidney function. Left untreated, high blood pressure can lead to a heart attack or stroke.
- Fluid overload. If you drink more fluids than recommended, you may retain enough fluid to cause life-threatening complications, such as heart failure or fluid accumulation and swelling in your lungs (pulmonary edema).
- Inflammation of the membrane surrounding the heart (pericarditis). Insufficient dialysis can lead to inflammation of the membrane surrounding the heart, which can interfere with your heart's ability to pump blood to the rest of your body.
- High potassium levels (hyperkalemia). The kidneys normally remove excess potassium from the body. If your kidneys are failing and you eat more potassium than recommended, your potassium level may become higher than normal. In extreme cases, too much potassium can cause your heart to stop.
- Infection. Potentially dangerous infections can occur at the site where blood leaves your body to be filtered and then re-enters.
- Depression. Many people on dialysis experience depression and anxiety.
- Amyloidosis. Dialysis-related amyloidosis (DRA) develops when proteins in blood are deposited on joints and tendons, causing pain, stiffness and fluid in the joints. The condition is common in people who have received dialysis for more than five years.
References
- Treatment methods for kidney failure: Hemodialysis. National Institute of Diabetes and Digestive and Kidney Diseases. http://kidney.niddk.nih.gov/Kudiseases/pubs/hemodialysis. Accessed Dec. 5, 2008.
- Dialysis in the treatment of renal failure In: Fauci AS, et al, eds. Harrison's Principles of Internal Medicine. 17th ed. United States of America: The McGraw-Hill Companies Inc.; 2008. http://www.accessmedicine.com/popup.aspx?aID=2881062&print=yes. Accessed Aug. 24, 2008.
- Hemodialysis. National Kidney Foundation. http://www.kidney.org/ATOZ/atozItem.cfm?id=35. Accessed Aug. 24, 2008.
- Berns JS. Patient information: Hemodialysis. http://www.uptodate.com/home/index.html. Accessed Aug. 26, 2008.
- Berns JS. Patient information: Renal replacement therapy. http://www.uptodate.com/home/index.html. Accessed Aug. 26, 2008.
- Berns JS. Patient information: Chronic kidney disease. http://www.uptodate.com/home/index.html. Accessed Sept. 10, 2008
- Kliger AS. Frequent nocturnal hemodialysis - A step forward? Journal of the American Medical Association. 2007;298:1331.
- Mailloux LU. Dialysis modality and patient outcome. http://www.uptodate.com/home/index.html. Accessed Aug. 26, 2008.
- Ricci Z, et al. Dose and efficiency of renal replacement therapy: Continuous replacement therapy versus intermittent hemodialysis versus slow extended daily dialysis. Critical Care Medicine. 2008;36(suppl):S229.
- McFarlane PA, et al. The quality of life and cost utility of home nocturnal and conventional in-center hemodialysis. Kidney International. 2003;64:1004.
