Hemodialysis is a very important procedure that saves lives when the kidneys are not working enough. This procedure can cause some important side effects and complications.

Many problems can occur in this process, which is based on removing the blood from the body and cleaning it in the dialysis machine. Some complications arise from a fluid – electrolyte imbalance in the body and this imbalance causing an effect on blood pressure and heart function.


To prevent hemodialysis complications, your nephrologist, your dialysis team, and you should work together. Being knowledgeable about the causes and symptoms ensures that if a complication does occur, it can be acted upon quickly. In this way, you will live longer and healthier.


1. Hypotension

Hypotension is the medical term for low blood pressure. The dose and speed of fluid removal procedure in the dialysis process are effective in this situation. These events can lower the internal blood pressure that can cause the following symptoms:

  • Abdominal discomfort
  • Yawning or sighing
  • Nausea
  • Vomiting
  • Muscle cramps
  • Restlessness


Significant drop in blood pressure can increase the risk of blood clots. If left untreated, surgery may be required to repair the access point. 

Adhering to the recommended fluid restriction and being aware of it can help this situation. By limiting your fluid intake, the amount extracted during the dialysis process will be reduced. The decrease in blood pressure will be tried to be minimized.


2. Fluid Overload

Fluid overload, also referred to as hypervolemia, occurs when the kidneys cannot get enough fluid from the body. The dialysis machine must be properly calibrated, otherwise, this problem may remain despite treatment.

Some of the symptoms of hypervolemia :

  • Headache
  • Abdominal cramping and bloating
  • Swelling of the feet, ankles, wrist, and face
  • High blood pressure
  • Weight gain

Fluid restriction is also an important precaution for such complications. However, if the overload continues, report this to your nephrologist so that an adjustment to your treatment plan can be planned.

3. Dialysis Disequilibrium Syndrome

Dialysis imbalance syndrome (DDS) is a rare condition seen in people who started hemodialysis recently. The body sees dialysis as an abnormal condition. This can cause the release of inflammatory cytokines and other inflammatory chemicals that cause swelling of the brain (brain edema).

Some symptoms that can be linked to DDS:

  • Weakness
  • Dizziness
  • Nausea and vomiting
  • Headache
  • Muscle cramps
  • Changes in behavior or mental status

Usually, the problem is resolved as the body begins to adapt to the treatment. It is a short-term complication. Sometimes intravenous saline is used together with a mannitol (a diuretic) to raise blood pressure and to reduce swelling and pressure around the brain.

4. Electrolyte Imbalance

Hemodialysis removes toxins and excess fluid from the body. but it also gets most of the electrolytes the body needs to function. Adhering to a diet usually solves this problem. However, if you have diabetes or use angiotensin receptor blockers, simply adhering to a diet may not be enough to resolve a condition known as hypokalemia.

Hypokalemia is abnormally low potassium in the blood. Potassium is one of the most important electrolytes that regulates fluid balance, muscle contractions and nerve signals in the body. When potassium levels drop too low, it can cause : 

  • Fatigue
  • Weakness
  • Constipation
  • Muscle cramping
  • Heart palpitations

If you follow a diet and treatment plan prescribed for you, your risk of hypokalemia is low. 

Also many people undergoing hemodialysis may experience itchy skin. This problem, which can occur between dialysis sessions, is caused by the accumulation of minerals in the body.


Let your team know if your skin itches abnormally. They may recommend moisturizing creams to comfort your skin and relieve itching.

5. Infection

Infection is a risk that may occur in people who are undergoing hemodialysis. Due to the established connection between the outside and the body, it creates an opportunity for bacteria and other microorganisms to enter the bloodstream. Some symptoms that indicate an infection is occurring include:

  • Local swelling, redness, warmth, and pain
  • Flatulence 
  • Fever and chills

Antibiotics are used to cure the infection. One type of blood thinner, heparin, can be used to prevent blood clots. Attention to hygiene can significantly reduce the risk of infection.

It is important to avoid bumping the dialysis port, especially if the graft or fistula procedure is new. It may cause bleeding. Bleeding can cause infection and swelling of the artery wall.

Also Sepsis (blood poisoning) is more likely to occur in hemodialysis patients. Bacteria enter the body from here. It spreads through the blood. It can lead to multi-organ failure. 

Symptoms are dizziness and high temperature. If you have a high fever, call your dialysis center.

In the case of sepsis, you need to be hospitalized. You will be treated with antibiotic injections.

Some other side effects of hemodialysis :

  • trouble falling asleep or being unable to stay asleep
  • bone and joint aches
  • decreased libido
  • dry mouth
  • anxiety


References :

  1. https://www.verywellhealth.com/complications-at-hemodialysis-cramps-aches-pains-more-3954362
  2. https://www.mayoclinic.org/tests-procedures/hemodialysis/about/pac-20384824
  3. https://www.nhs.uk/conditions/dialysis/side-effects/