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Signs of Hemodialysis Complications and How to Prevent Them

Starting dialysis is a major life change for most people, and it can take time to adjust. Several treatment options are available, including hemodialysis (HD), which can be done either at home or in a center. If you choose hemodialysis, it’s important to know the signs of common hemodialysis complications so you can recognize them quickly and let your care team know.

What Is Hemodialysis?

Hemodialysis is a treatment for end stage renal disease (ESRD). It uses an external artificial kidney to filter waste, toxins, and extra fluid from your blood when your kidneys no longer can. The frequency and duration of your dialysis sessions is determined by your doctor. Many people who dialyze in centers will come in 3 times a week for 4-hour sessions. Home HD can be more flexible based on your personal schedule and treatment needs.

5 Signs of Hemodialysis Complications

Like most other healthcare treatments, there can be complications when it comes to hemodialysis that may arise during or after treatments. The best way to manage complications that can occur with hemodialysis is to prevent them from happening or getting worse. Keep an eye out for these common signs of hemodialysis complications as you navigate your treatment.

1. Hypervolemia (fluid overload)

Hypervolemia, or fluid overload, is the medical term for having too much fluid in your body. Properly functioning kidneys remove excess fluid, so it’s common for people with chronic kidney disease (CKD) or ESRD to experience a buildup of fluid. Symptoms of too much fluid include rapid weight gain, noticeable swelling, high blood pressure, shortness of breath—especially when doing simple activities or lying down—and a cough or coughing.

Fluid overload is a problem because it can cause increased blood pressure, heart problems, hospitalization, and death in patients with ESRD. You can help prevent hypervolemia by following these tips:

  • Complete all dialysis treatments as prescribed and reschedule any missed treatment
  • Limit or reduce your sodium intake 
  • Measure and track how much fluid you drink and stay within your fluid guidelines 
  • Record your weight and note any gains that could indicate fluid buildup
  • Find ways to manage thirst
  • Manage your diabetes to keep blood sugar in target range

2. Low blood pressure

Low blood pressure during hemodialysis, called intradialytic hypotension, can happen for a number of reasons. Common causes include gaining too much weight between treatments, removing too much fluid during treatment, taking certain medications, heart disease, and eating during treatments. The drop in blood pressure can cause muscle cramping, which is uncomfortable. Low blood pressure can also cause headaches, nausea, abdominal pain, and lightheadedness.1

Avoid low blood pressure during your treatment by managing your fluid gains between treatments and not eating during dialysis (unless you have diabetes that requires you to eat while dialyzing). Also, make sure your care team has an updated list of all medications you take at home.

3. Infection

Hemodialysis requires an access site to be able to filter your blood. Your access site is your lifeline and needs proper cleaning and care to prevent infection. Keep your access site clean and dry. Check for any signs of an infection, which include redness, drainage, pus, pain at the site, swelling, warmth, or fever. Practicing proper hand hygiene and protecting your access site can help prevent infection.

4. Itchy skin

Dry, itchy skin, also known as pruritus, can be caused by several factors.2 Here are a few to watch out for:

  • Dry skin: Avoid using skin care products that contain alcohol, alpha-hydroxy acid, fragrance, and retinoids. Limit your time in the shower or bath to 10 minutes and use warm water instead of hot.
  • High phosphorus level: Be sure to take any phosphate binders as prescribed.
  • Not getting enough dialysis: Stay for your entire treatment time and reschedule any missed treatment.
  • Allergies: Use fragrance-free skin care products and laundry detergents that are labeled “hypoallergenic.” Dermatologists have additional tips for relieving dry skin.
Learn More About Pruritus. Watch This Video

5. General discomfort

Hemodialysis sessions often take several hours at a time, and it’s not uncommon to feel uncomfortable sitting for a long period. If you feel discomfort or coldness due to dialysis, be sure to mention it to your care team. They are dedicated to making your dialysis experience comfortable. You can also consider wearing comfortable clothing and bringing a blanket if your dialysis center permits it.

Getting to Your Comfort Zone

As with any life changes, you may experience complications when starting hemodialysis. Those complications can be easily treated if you know how to spot them.

Be sure to let your care team know if you experience any changes to your overall health, such as fever, shortness of breath, itchy skin, headaches, or other symptoms of common hemodialysis complications, so that you can succeed and thrive with dialysis.


1Veeraish Chauhan, “Blood Pressure From Hemodialysis Signs and Prevention,” Verywell Health, last modified July 31, 2020,

2 “Dialysis: Dry, Itchy Skin,” National Kidney Foundation, accessed April 6, 2022,

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