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Some Physical Side Effects of Dialysis and How to Prevent Them

Dialysis is a lifesaving treatment for those with end stage renal disease (ESRD). However, with both peritoneal dialysis (PD) and hemodialysis, there are occasions when a patient may have side effects from the treatment.

These side effects can be mild or severe, depending on the patient’s condition and whether or not they are following their dietary and fluid restrictions. Most of these side effects can be managed if the patient carefully follows their healthcare team’s recommendations regarding diet and fluid intake. 

Side effects of peritoneal dialysis (PD)

Infection

PD is a method of home dialysis. All three types of peritoneal dialysis—Continuous Ambulatory Peritoneal Dialysis (CAPD), Continuous Cycler-assisted Peritoneal Dialysis (CCPD) and Nocturnal Intermittent Peritoneal Dialysis (NIPD)—need a small rubber tube called a catheter. The catheter, a soft, straw-like tube is positioned both inside and outside of the body to allow dialysis solution into and out of the abdominal cavity. Exchanges (the process of filling, dwelling and draining dialysis solution) must be done carefully because there is a risk of infection from bacteria on the outside of the body.

In Continuous Ambulatory Peritoneal Dialysis, an exchange is done up to four or five times a day, seven days a week. The frequent handling of the catheter means greater risk for infection. Although patients doing Continuous Cycler-assisted Peritoneal Dialysis and Nocturnal Intermittent Peritoneal Dialysis at night with the help of a cycler handle the catheter much less, there is still a chance of peritonitis, which is an infection of the peritoneum (where the catheter is placed in the abdomen.) This infection is the most common side effect of PD. Peritonitis can cause fever, nausea, vomiting and stomach pain. Patients may notice their dialysis solution looks cloudy. Treating peritonitis quickly is the key to stopping widespread infection. The doctor will likely prescribe antibiotics. Skin infections around the catheter insertion site are also common. If the area becomes red or inflamed, a visit to the doctor is recommended.

Preventing infection

To decrease the chance of infection, patients are advised to perform each exchange carefully. Exchange should be performed in a clean area. Keeping the catheter area clean and touching it with washed hands or sterile gloves can minimize the transfer of bacteria. Patients may also be advised to apply an antibiotic preparation at their catheter exit site to prevent infection.

Some patients have problems attaching or detaching the dialysis solution bag, which could put stress on the catheter, causing tiny tears that could allow in germs. If a patient has difficulties handling the bag, a renal nurse can provide tips on how to properly connect the bag to the catheter.

If a patient notices any sign of infection, it’s best to call the doctor immediately.

Hernias

A hernia is another potential side effect of PD. The muscles of the abdominal wall protect the internal organs and keep them in place. The insertion of a catheter can weaken these muscles. When patients do an exchange, the pressure from the dialysis solution in the peritoneum pushes against these already weak muscles. This pressure could cause a tear, and organs from the abdominal cavity could emerge through the opening.

Surgery is the only way to repair a hernia. Patients who have a history of hernias are advised not to exert themselves or participate in activities that could strain the abdominal muscles.

Nutrition

Some PD patients find eating uncomfortable, because of the full feeling from the dialysis solution in their stomach area.  Although eating less feels better, it can lead to malnutrition.

The PD renal diet is designed to meet patients’ nutritional needs. If patients eat less, they may not get enough of the proteins and minerals that are important for good health. Timing exchanges (generally after meals) helps relieve some of the discomfort. 

Bloating and weight gain

Bloating and weight gain are common complaints while on PD. Some of the weight gain is fluid bloat from the dialysis solution sitting in the peritoneum. The dialysis solution filters not only the toxins from the bloodstream, but also removes excess fluid. When the dialysis solution is drained, a patient will normally remove more fluid (dialysis solution plus the excess fluid filtered from the blood) than what was originally placed in the peritoneum.

Weight gain not associated with fluid bloat can come from the sugar in the dialysis solution being absorbed by the body. These extra calories could lead to extra pounds. Talking to a renal dietitian and nurse for some insight on how to balance nutritional needs and achieve comfort while on PD is advised.   

Side effects of hemodialysis

Low blood pressure

The most common side effect of hemodialysis is low blood pressure (also called hypotension). Low blood pressure occurs when too much fluid is removed from the blood during hemodialysis. This causes pressure to drop, and nausea and dizziness can result. Letting a dialysis team member know about these issue is highly recommended. The dialysis machine can be programmed so that the right amount of fluid is removed. 

Medication for high blood pressure should usually not be taken before treatment, unless the doctor prescribes it that way. This could cause further drops in pressure and more discomfort. Watching and limiting fluid intake as recommended by the healthcare team may also prevent low pressure during treatments. Patients who drink more than what is advised usually need to have more fluid removed which can cause nausea and dizziness.

Muscle cramps

Patients sometimes experience muscle cramps while undergoing hemodialysis. These muscle cramps, usually in the legs, can be uncomfortable or sometimes painful. The exact cause of muscle cramps can vary from patient to patient. Sometimes when fluid is taken out of the body at a fast rate during dialysis or too much fluid is removed, the muscles react by cramping. A patient should alert a healthcare team member as soon as a cramp happens to get help in alleviating the discomfort. A doctor may be able to recommend some remedies if muscle cramps are making dialysis treatment uncomfortable.

Infection and clotting

Proper care for the access (either a fistula or a graft) is important in hemodialysis. The access can become infected or inflamed. Pressure on the access (from clothing or from sleeping on the side where the access is located) can cause the site to become irritated. Keeping the area clean can help prevent infection. 

An access can become clotted with blood. Clotting prevents blood flow, so that a patient will not be able to get dialysis treatment. Patients are advised to monitor the access daily by checking for the thrill (the pulse feeling in the fistula or graft) to ensure it is working properly. 

Itching

Many dialysis patients complain about itchy skin. There may be several causes, but it is commonly thought that high phosphorous levels are responsible for this side effect. Phosphorous is not effectively removed by dialysis. That’s why foods with phosphorus are restricted on the renal diet. Following the dietitian’s guidelines can help prevent this side effect. Remembering to take a phosphorus binder as prescribed (usually before every meal) is another way to help prevent or stop itching.

Dialysis patients are also prone to dry skin, which can be the cause of itching. Using very hot water for showers or baths can dry skin more. Harsh soaps can cause irritation and more itching. Moisturizing creams can alleviate some of the discomfort.

Sexual side effects for PD and hemodialysis

Dialysis can affect a patient’s sex life. The sexual side effects can include loss of desire, erectile dysfunction and vaginal dryness. Loss of desire can be a psychological side effect. Patients on dialysis may deal with anxiety, depression and a change in self-image. These mental challenges can diminish the sex drive. 

Hormone levels while on dialysis can also lead to a loss of desire, as well as physical side effects such as erectile dysfunction and vaginal dryness. Certain blood pressure medications can impair the ability to maintain an erection.

Patients should talk to their social workers or doctors if they experience any of these symptoms. 

Keep an open communication with the healthcare team. Let them know about any reactions to treatment so adjustments can be made. Side effects should not discourage a patient from continuing dialysis, especially since many of these side effects can be controlled.

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