Possible problems with hemodialysis

Hemodialysis is a much more intensive treatment than peritoneal dialysis: all the dialysis is condensed into a few sessions a week. Many potential problems with hemodialysis are due to this fact.

Rapid changes in blood pressure
The speed at which water is removed from the blood during hemodialysis may cause a sharp drop in blood pressure. This makes some patients feel unwell, either during or after the treatment session. Fainting, vomiting, cramps, temporary loss of vision, chest pain, irritability, and fatigue can occur.

Fluid overload
Hemodialysis patients sometimes develop a condition called fluid overload between dialysis sessions. Excess water collects under the skin at the ankles and elsewhere in the body, including the lungs.

To avoid fluid overload, hemodialysis patients should restrict the amount of fluid they drink. This also helps avoid the problems caused by rapid physical changes during hemodialysis.

Restrictions on fluid intake for hemodialysis patients are stricter than those for peritoneal dialysis patients.

Hyperkalemia
Hyperkalemia is caused by too much potassium in the blood and can interfere with the heart's rhythm. Severe hyperkalamia can cause the heart to stop.

Most hemodialysis patients are asked to restrict their intake of foods that contain a lot of potassium.

Loss of independence
Although patients on hemodialysis have "days off", some feel that having to travel to the Dialysis center or self-care unit several times a week, every week of the year, is a burden.

Home hemodialysis and peritoneal dialysis patients do not have this burden since they are treated at home.

Blood-borne viruses
Some patients have concerns about contracting blood-borne viruses, such as hepatitis B or C, or HIV. All Dialysis centers take measures to protect patients from this risk. If you are concerned, you should discuss your concerns with the medical team.

Amyloidosis
Renal bone disease is not the only cause of bone pain in patients with kidney failure. Bone pain can also be caused by a condition called dialysis amyloidosis.

This condition can develop 10 years or so after the start of dialysis. It is caused by the build up of a protein called amyloid, which is not easily removed by dialysis. It is deposited in joints all over the body, leading to joint and bone pain. At present there is no effective treatment for this condition. It can be halted, to an extent, by transplantation.

Other potential problems with hemodialysis, described below, are related to access.

Fistulas
Not all fistulas work perfectly. Some never develop into a vein that is large enough. Some work well for years and then suddenly stop. In either case, a new fistula (or sometimes a graft) will have to be made in another part of the body. Only a limited number of veins can be made into a fistula. Caring for the fistula is important.

Access can be a particular problem for patients with diabetes or for children since the blood vessels are often very narrow.

HD catheters
HD catheters may stop working because they become blocked by a blood clot. If this happens, they will have to be declotted or replaced. Only a limited number of veins are suitable for catheter insertion.

Needles
If access is achieved via a fistula or graft, it is necessary to insert needles at the start of each dialysis session. Even with a local anesthetic, some patients find this painful.

Bleeding
Some patients may have problems with bleeding from the fistula either during or after dialysis. There are now special bandages available which can help stop the bleeding more quickly. Most Dialysis centers can supply these or advise where they can be obtained.

Infections
There is a risk of picking up an infection during a dialysis session. Infections can usually be treated with antibiotics. Strict attention to hygiene during the preparation of the dialysis machine and access can help prevent infection.

Exit site infections may occur where a dialysis catheter comes out of the skin. The area around the exit site becomes red and inflamed. The infection can "tunnel" inside the body, following the route of the catheter. Most exit site infections respond well to antibiotics.

Some people feel anxious before starting dialysis.

"I am very nervous, but eventually decided to go ahead with it. I am particularly fearful of whether it will be visible. Also, I don't like needles. At the moment I don't mind coming here (to the Dialysis center), but wonder if I will dread it when they start using the fistula." - Anon

Most people get used to it after a while.

"It had to be done. I'm not bothered about how it (the fistula) looks; only occasionally I notice it in the mirror. It's a way of life - it's my lifeline" - Ron Broad

May 1, 2006