Table of ContentsView AllTable of ContentsInfectionHypotensionElectrolytesFluid OverloadDDS
Table of ContentsView All
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 ofdialysisaccess, through which blood is removed from the body and cleaned in a dialysis machine.
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Preventing complications of hemodialysis requires careful management on the part of yournephrologist(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:
Antibiotics are typically used to treat the infection.Heparin, a type of blood thinner, may be used to prevent blood clots andlimb 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).
5 Complications of Hemodialysis
Hypotension, orlow 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:
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.
Low 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 takeangiotensin-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.Potassiumis 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:
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.
Symptoms of Low Potassium (Hypokalemia)
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:
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, includingcongestive heart failure, cardiac arrhythmia, andcardiomegaly(enlargement of the heart).
Understanding 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 inflammatorycytokinesand other inflammatory chemicals that cause the brain to swell (cerebral edema).
Symptoms of DDS include:
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 thekidneys, 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 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto 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.2016.05.021National 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.1103623Elliott 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:10.1186/1471-2369-14-266National 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
8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto 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.2016.05.021National 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.1103623Elliott 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:10.1186/1471-2369-14-266National 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
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto 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.2016.05.021National 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.1103623Elliott 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:10.1186/1471-2369-14-266National 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
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
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