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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’re following their dietary and fluid restrictions. Most of these side effects can be managed if the patient carefully follows their healthcare team’s dietary and fluid intake recommendations.
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 is positioned 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 to mitigate the risk of infection.
In CAPD, an exchange is done up to four or five times a day, seven days a week. Although patients doing CCPD and NIPD with the help of a cycler handle the catheter much less, there’s still a chance of peritonitis, which is an infection where the catheter is placed in the abdomen. 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.
To decrease the chance of infection, exchanges should be performed in a clean area. Patients may also be advised to apply an antibiotic preparation at their catheter exit site.
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. 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 proteins and minerals. Timing exchanges (generally after meals) helps relieve some of the discomfort.
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.
Weight gain can also come from the sugar in the dialysis solution being absorbed by the body andlead to extra pounds. Talk to a renal dietitian and nurse to learn how to balance nutritional needs and achieve comfort while on PD.
Side effects of hemodialysis: Low blood pressure
The most common side effect of hemodialysis is low blood pressure. It can occur when too much fluid is removed from the blood during hemodialysis. This causes pressure to drop, and nausea and dizziness can result. Tell your dialysis team if you experience any of these issues.
Medication for high blood pressure should usually not be taken before treatment, unless the doctor prescribes it that way.
Patients sometimes experience muscle cramps while undergoing hemodialysis. 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 doctor may be able to recommend some remedies.
The access (either a fistula or a graft) can become infected or inflamed with hemodialysis. Pressure on the access 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 a patient won’t 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’s working properly.
There may be several causes, but it’s commonly thought that high phosphorous levels are responsible for itchy skin. Phosphorous isn’t effectively removed by dialysis so foods with phosphorus are restricted on the renal diet. Following the dietitian’s guidelines and taking a phosphorus binder can help prevent this side effect. Dialysis patients are also prone to dry skin, which can be the cause of itching. Avoid hot showers and harsh soaps, and use . moisturizing creams.
Dialysis may cause sexual side effects, whichcan include loss of desire, erectile dysfunction and vaginal dryness. Patients may also deal with anxiety, depression and a change in self-image, which may diminish the sex drive.
Patients should talk to their social workers or doctors if they experience any of these symptoms.
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