I hope you enjoy reading this blog post. It has been written and vetted by RenalTracker's team of kidney experts and researchers. The same team was awarded the KidneyX Prize organized by the American Society of Nephrology and HHS for pre-dialysis solution in Washington DC in 2019.   

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Dialysis is a life-saving procedure to people with kidney failure. Because of this treatment, it is possible for those with low kidney function to live relatively normal lives.

However, there's one important thing we have to remember. Despite how helpful it has been to kidney disease patients all over the world, dialysis is not a cure for kidney failure.

Dialysis cannot return the kidney function you've lost. It cannot bring your kidneys back to a healthier state. At most, it's a stopgap measure—a way to buy more time as you await the more long-term solution. Often, this means a kidney transplant.

How effective is dialysis?

There have been great strides in kidney disease treatments in the last couple of years. But there's still room for improvement. At present, dialysis can’t be considered a complete alternative to having healthy kidneys.

Your kidneys have many functions:

  1. Removing waste products and drugs from your body
  2. Balancing the body’s fluids
  3. Releasing hormones that regulate blood pressure
  4. Producing an active form of vitamin D (that helps keep your bones healthy)
  5. Controlling the production of red blood cells

Dialysis can only partially replace the first two of these: removing excess water and some waste products. And compared to healthy kidneys, dialysis is only 3% to 5% as effective at performing these functions.

Aside from that, you may experience complications or side effects. As is the case for many medical procedures, there's always a chance that something might go wrong. This is true for both hemodialysis and peritoneal dialysis.

Contact your treating nephrologist or kidney nurse if you are concerned that you may be experiencing any of the side effects mentioned in this blog.

Side Effects and Complications: Hemodialysis vs Peritoneal Dialysis

While they may be life-saving, hemodialysis and peritoneal dialysis are still complex medical procedures that come with an inherent degree of risk. Side effects are unavoidable, no matter which type of dialysis you choose.

This is something you should always be aware of. Being aware and vigilant is the first step to managing complications and possibly minimizing their effects.

Hemodialysis Side Effects and Complications

1. Muscle Cramps

Cramps are a result of the involuntary contraction, or tightening, of your muscles. They often last only a few seconds, but they can be very painful.

Some patients experience muscle cramps when undergoing hemodialysis. Leg muscles are the most often affected. The muscles in your hands, arms, and abdomen may also cramp, although this is less common. In some cases, muscle cramps are so severe that a patient will have to stop hemodialysis.

The exact cause of cramps is not yet known. Early research suggests that the loss of fluid may be the culprit. Too many or too little electrolytes in your blood could also play a role.

Consult your healthcare provider if you experience extremely painful muscle cramps. Limiting your fluid intake may reduce the occurrence of cramps. Medication might help you deal with the symptoms as well.

2. Low Blood Pressure

This is one of the most common side effects of hemodialysis.

During dialysis, a large amount of fluid is removed from your body at a rapid rate. This causes you to have low blood pressure (also called hypotension). When your blood pressure drops, you may feel other symptoms, like dizziness or nausea. 

In the long term, the consequences can be dire. Low blood pressure has been associated with many complications in dialysis patients. There is an increased risk of strokes, seizures, heart damage, and blood clotting. 

Blood clots that form at hemodialysis accesses are particularly dangerous. They may cause the access to become unusable. And without a functioning access, dialysis isn't possible.

You should keep track of your fluid intake between hemodialysis sessions. This can help prevent your blood pressure from dropping too much during treatment.

2. Other Side Effects

Hemodialysis patients also report experiencing:

  • Feeling cold

The dialysate used in hemodialysis is cooled and kept at a low temperature. This helps smaller blood vessels contract and makes dialysis more effective. But the result is that patients will always feel cold. This is not harmful, but it can be uncomfortable. Unfortunately, not much can be done to ease this side effect.

  • Tiredness and fatigue
  • Insomnia and/or difficulties staying asleep
  • Pain in the bones and joints
  • Erectile dysfunction and/or loss of libido
  • Dry mouth
  • Anxiety

Research suggests that more regular home hemodialysis sessions can help reduce side effects. With in-center hemodialysis, you'll have to wait longer between sessions. This may have an impact on your physical condition.

Peritoneal Dialysis Side Effects and Complications

1. Weight Gain

A cleansing fluid called dialysate is necessary for peritoneal dialysis. Dialysate contains a lot of sugar molecules that your body may absorb. This can add several hundred calories to your daily consumption.

If you don’t offset these extra calories with a good diet and exercise plan, you’re likely to gain weight. But don’t try to lose weight too quickly! Following fad diets or other extreme methods are more likely to harm than help.

2. Hernia

Hernia refers to a weakness in your abdominal muscles.

Those who do peritoneal dialysis have an increased risk of developing a hernia. This is because peritoneal dialysis puts a lot of strain on your abdominal muscles.

Hernias also develop near the site of a peritoneal dialysis catheter. The creation of an opening for the catheter causes stress to the muscles in this area.

The main sign of a hernia is swelling in the abdomen. The resulting lump can be painless and is sometimes only discovered during check-ups. Treating a hernia usually requires surgery.

Dangerous Infections: Hemodialysis vs Peritoneal Dialysis

People undergoing dialysis are more likely to contract infections. They visit hospitals or clinics frequently and have a compromised immune system. Infection can be the most life-threatening complication of both hemodialysis and peritoneal dialysis.

Hemodialysis: Sepsis (Blood Poisoning)

Hemodialysis patients have more points of entry for infection compared to the average healthy person. Their vascular access can become contaminated by bacteria. A fistula, graft, or catheter is a direct line to the bloodstream. Because of this, an infection can spread quickly and become fatal.

Sepsis, or blood poisoning, occurs as your body’s extreme response to infection. Common warning signs include:

  • Dizziness
  • Fever (temperature above 100.4ºF or 38ºC)
  • Extreme pain
  • Drowsiness or confusion
  • Cold shivers

This is one of the most telling signs of sepsis. If you feel cold and start shivering uncontrollably, contact your healthcare provider and seek immediate treatment. You will need to be admitted to a hospital.

Untreated, sepsis can lead to multiple organ failure and your body shutting down.

Peritoneal Dialysis: Peritonitis

The inner lining of your abdomen is called the peritoneum. Peritonitis refers to the bacterial infection of this part of your body.

Patients who undergo peritoneal dialysis have a high risk of peritonitis. Bacteria may enter the abdomen through (or around) the peritoneal dialysis catheter. To avoid this, the equipment used for treatment should be as clean as possible. The catheter site should also be cleaned regularly.

Most infections are mild and completely treatable. But sometimes, they can be severe. In these cases, or if the infection is recurring, you may have to switch to hemodialysis.

Symptoms include:

  • Mild to severe abdominal pain
  • Fever (temperature above 100.4ºF or 38ºC)
  • Nausea or diarrhea
  • Cloudy used dialysate fluid

If left untreated, peritonitis can be fatal.

Some Words of Caution

What we’ve presented here is by no means a complete list of all the possible complications of dialysis. We've tried to show you the most common and the ones with the most serious consequences.

If you are undergoing dialysis (or are about to), always listen to the advice of your dialysis care providers. Take special note of any instructions they have. Make sure that you are facing kidney failure with the odds in your favor.

And voiding complications doesn’t have to be complicated. Here are some simple tips you can apply right away:

1. Maintain good personal hygiene

Wash everyday. Wear clean clothes and underwear. Simple things like this can make a big difference. Being clean lowers the risk of infection and helps prevent life-threatening complications.

2. Keep a clean house

Keeping your surroundings clean and bacteria-free is just as important as keeping your own body clean. This is critical if you do dialysis at home.

3. Manage your fluid and salt intake

Monitoring your diet should become part of your routine if you are on dialysis. By limiting your fluid and salt intake to the recommended levels, you can keep your body in the best condition for dialysis.

And if you aren’t on dialysis yet, the best way to avoid complications is to avoid dialysis altogether. Do what you can to keep the level of kidney function you currently have.

Prevention is better than cure, or so they say. And while it may be a cliché, nothing could be more true.