Dialysis - Side effects of dialysis

Both haemodialysis and peritoneal dialysis cause side effects. This is because of the way dialysis is carried out and the fact that it can only compensate for the loss of kidney function to a certain extent.

Fatigue

Fatigue, where you feel tired and exhausted all the time, is a common side effect in people who have used both haemodialysis and peritoneal dialysis on a long-term basis. Fatigue is thought to be caused by a combination of:

• the loss of normal kidney function
• the effects that dialysis can have on the body
• the dietary restrictions associated with dialysis
• the overall stress and anxiety that many people with kidney failure experience

There are several treatment options that may help to improve the symptoms of fatigue.

You may want to talk to your dietitian to see if your diet can be adjusted to increase your energy levels. Research has also shown that regular aerobic exercise can improve the symptoms of fatigue.

If you are fatigued, starting a programme of regular exercise can be difficult, and many people who are on dialysis complain about feeling out of breath. However, if you persevere, you will find that exercising becomes easier with time.

Low-to-moderate aerobic exercise such as cycling, running, walking or swimming is recommended. Your GP or dialysis care team will be able to advise you about the type of exercise most suitable for you.

Haemodialysis

Low blood pressure

Low blood pressure (hypotension) is one of the most common side effects of haemodialysis. It can be caused by the drop in fluid levels during dialysis. Low blood pressure can cause nausea and dizziness.

The best way to minimise the symptoms of low blood pressure is to keep to your daily fluid intake recommendations. If your symptoms persist, you should consult your dialysis care team because the amount of fluid used during dialysis may need to be adjusted.

Invasive staphylococcal infections

People receiving haemodialysis are at increased risk of developing invasive staphylococcal infections. These infections are caused by staphylococcus aureus bacteria, which are usually responsible for minor skin infections such as boils.

However, the haemodialysis process can allow the bacteria to enter the body where they can cause a more serious infection that can spread through the blood, leading to multiple organ failure. This is known as sepsis or blood poisoning.

Sepsis associated with an invasive staphylococcus infection is the second most common cause of death, after heart disease, in people receiving haemodialysis.

The first symptoms of an invasive staphylococcal infection include:

• a high temperature (fever) of 38^oC (100.4^oF) or above
• dizziness, which is related to a decrease in blood pressure, or a worsening of low blood pressure if you already have it

If you have a high temperature, phone your dialysis unit immediately for advice. Alternatively, you can contact NHS 111 or your local out-of-hours service.

If you develop an invasive infection, you will need to be admitted to hospital and treated with injections of antibiotics. Read more about treating staphylococcal infections.

Muscle cramps

During haemodialysis, some people experience muscle cramps, usually in their lower legs. This is thought to be caused by the muscles reacting to the fluid loss that occurs during haemodialysis.

Consult your dialysis care team if you have muscle cramps that become particularly painful. Medication may be available to help you cope with the symptoms.

Itchy skin

Many people receiving haemodialysis experience itchy skin. This is thought to be due to a build-up of potassium in the body. Avoiding foods that are rich in potassium can help reduce the frequency and severity of itching. Some people have also found that using moisturising cream can minimise the discomfort caused by itching.

Other side effects

Other side effects of haemodialysis include:

• difficulties falling asleep (insomnia) or staying asleep
• bone and joint pain
• loss of libido (sex drive)
• dry mouth
• anxiety 

Peritoneal dialysis

Peritonitis

A common side effect of peritoneal dialysis is bacterial infection of the peritoneum (peritonitis). Peritonitis can occur if the dialysis equipment is not kept properly sterilised (free of germs). If there are bacteria on the equipment, they can be passed into the peritoneum.

Lack of appetite and nausea are the initial symptoms of peritonitis. These are quickly followed by abdominal pain, which usually begins as a dull ache in your abdomen before progressing to a steady, severe pain.

Peritonitis is treated with injections of antibiotics (intravenous antibiotics). The antibiotics are usually injected directly into the tissue of the peritoneum.

The most effective way to prevent peritonitis is to keep your dialysis equipment clean. You will be given training in how to do this. If you experience repeated episodes of peritonitis, it may be that you are not a suitable candidate for peritoneal dialysis. If this is the case, you should change to haemodialysis.

Hernia

People receiving peritoneal dialysis are at increased risk of developing a hernia because holding fluid inside the peritoneal cavity for many hours puts a strain on the muscles of the abdomen.

The main symptom of a hernia is the appearance of a lump in your abdomen. The lump may be painless and may only be discovered during a check-up. In some people, certain activities, such as bending over or coughing, can cause a hernia to become painful.

Surgery is usually needed to repair a hernia. During surgery, the surgeon will place the protruding intestine or tissue back inside your abdominal wall. The muscles of the abdominal wall will also be strengthened using a synthetic mesh.

Weight gain

The dialysate fluid used during peritoneal dialysis contains sugar molecules, some of which are absorbed into your body. This can increase your daily calorie consumption by up to several hundred calories a day.

If you do not compensate for these extra calories by reducing the amount of calories that you eat and by taking regular exercise, it is likely that you will gain weight. In a minority of cases, the weight gain can be excessive.

One study found that around 7% of people having peritoneal dialysis will gain around 10kg (two stone) over the course of two years.

If you are concerned that you are gaining too much weight, you should talk to your dialysis team who can recommend a diet and exercise plan that can help you lose weight.

Avoid using fad diets that claim to be able to help you lose a lot of weight quickly. This type of extreme dieting could upset your body’s chemistry and make you feel very ill.