Complications of haemodialysis
Haemodialysis, like peritoneal dialysis, is not easy. It is hard work every day, partly as its not that effective. Both forms of dialysis provide about 5% of the function of two normal kidneys. Nonetheless if it works well, it can keep you alive for many years.
However, as for any life-saving long-term treatment, there are complications. We will now go through the short, medium and long-term complications of haemodialysis.
Short-term complications
Low blood pressure (hypotension). A drop in blood pressure is a common side effect of haemodialysis, especially at the start of the procedure. Low blood pressure may be accompanied by shortness of breath, abdominal cramps, muscle cramps, nausea or vomiting.
When the fall in blood pressure is severe and rapid it is sometimes called ‘crashing’, and you may lose consciousness. The nurses treat this by giving your a burst of intravenous (IV) fluids quickly.
Muscle cramps. Although the cause is not clear, muscle cramps (especially in the legs) during haemodialysis are common. Sometimes the cramps can be eased by adjusting the haemodialysis prescription. Adjusting fluid and sodium intake between haemodialysis treatments also may help prevent symptoms during treatments.
Fluid overload. Since fluid is removed from your body during haemodialysis, drinking more fluids than recommended between haemodialysis treatments may cause life-threatening complications, such as fluid overload. This shows itself as an accumulation of water in your lungs (pulmonary oedema) causing shortness of breath. Again, the nurses need to act quickly to remove more fluid.
High potassium levels (hyperkalaemia). Haemodialysis removes extra potassium, which is a mineral that is normally removed from your body by your kidneys. Having a normal blood potassium level is needed for the heart to beat properly. But if too little potassium is removed during dialysis, blood potassium levels rise, and your heart may beat irregularly or stop.
In a minority of patients a low potassium level (hypokalaemia) can occur. This also affects the heart function.
‘Dialysis disequilibrium syndrome’. This syndrome can occur when waste products are removed too rapidly from the blood, causing symptoms such as headache, nausea, vomiting, confusion, and seizures.
Allergic reactions. Some individuals may experience allergic reactions to the dialysis membrane or the substances used during the dialysis process.
Medium-term complications
Problems with fistulas
Narrowing. Fistulas can slowly narrow (forming a ‘stenosis’). There are usually warning signs before blockage, such as difficulty needling, poor flows or extended post dialysis bleeding when the needles have been removed. If this happens the veins should be checked for narrowings. This will involves a scan of your fistula. If there is a narrowing in your fistula this can be treated by having a ‘fistuloplasty’ procedure, in the x-ray department.
Blocking. If a blood clot blocks your fistula completely, you will not be able to feel the ‘buzz’ of the fistula. If this happens, you need to tell your renal team urgently, and go to the hospital. A rapid x-ray procedure or operation is needed to remove the blood clot and get it going again. This is more likely to work if you seek help urgently.
Problems with lines
Blockage. Lines can also block. If your line blocks, it may be possible to unblock it with ‘clot busting’ drugs, or to replace it with a new one.
Infection. Lines can get infected. Keeping a clean dressing over the line reduces the chances of infection. Infection on the line can show itself as either pus (a dirty discharge on the dressing) around the entry point of the line; or blood poisoning with fever and shivers on dialysis. Antibiotics will be required. If they do not work, the line will have to be removed.
Long-term complications
Long-term viral infection. Great efforts are made by the nurses to keep all the machines, lines and blood transfusions clean and free of viruses like Hepatitis B and C and HIV. Nonetheless there is always a very small chance of the patient being infected (in the long-term) with these viruses.
Summary
We have described complications of haemodialysis. We hope it has been helpful.
Other resource
There is more information on complications of haemodialysis written by the renal team at UHCW Coventry.
Last Reviewed on 14 November 2023