Potential Complications of Dialysis

By Mayo Clinic Staff
http://www.mayoclinic.com/

Dialysis is an essential medical treatment if you have kidney disease, but complications can arise. Here's what you need to know and what you can do to reduce the risks. If you require hemodialysis or peritoneal dialysis to treat end-stage renal disease (ESRD), you and your health care team will work together to prevent complications. Be alert to possible complications and take steps to avoid them.

Complications of dialysis and ESRD: What are they?

Your kidneys play a role in many of your body's systems. When your kidneys stop working, these other systems don't work as well as they did before. Unfortunately, this leads to complications. These complications include:

Anemia
If you have anemia, you don't have enough red blood cells in your bloodstream. Red blood cells are important because they carry oxygen. Causes of anemia for people on dialysis include:

- Lack of erythropoietin, a hormone made by healthy kidneys that tells your bone marrow to make red blood cells
- Blood loss from bleeding, dialysis and blood sampling
- Less than normal amounts of iron or vitamins in your blood because of diet restrictions, poor absorption of iron, or removal of iron and vitamins by dialysis

Bone diseases
People who have ESRD typically experience changes in how well their bodies absorb calcium, phosphorus and vitamin D. This can lead to weakened bones (renal osteodystrophy). As a result of these changes, people with ESRD may develop:

- Osteomalacia. This happens when your damaged kidneys are no longer able to change vitamin D into the form that promotes calcium absorption.
- Osteitis fibrosis. This condition results from overactive hyperparathyroid glands (hyperparathyroidism) — a condition in which your parathyroid glands produce too much parathyroid hormone. Too much of this hormone causes your body to remove calcium from your bones, which weakens your bones.
- Calcium-phosphorus deposits. When levels of calcium and phosphorus in your blood get out of balance, calcium and phosphorus crystals can form in your heart, lungs, skin, blood vessels and joints. Calcium deposits that form in your skin cause inflammation, which can turn into painful skin ulcers (calciphylaxis).

High blood pressure (hypertension)
If you have high blood pressure as well as kidney disease, your high blood pressure will worsen if you eat too much salt or drink too much fluid. Left untreated, high blood pressure can cause:

- Damage to your blood vessels that may lead to a stroke or heart attack
- Congestive heart failure or other heart diseases
- Blindness
- Worsening kidney function

You and your health care team will closely monitor your blood pressure.

Fluid overload
If you don't follow your treatment plan, such as drinking more liquid than is recommended, you'll likely retain too much fluid in your body. When the level of fluid your body retains gets too high, the situation can become critical. You can develop congestive heart failure or pulmonary edema.

Pericarditis
Pericarditis is an inflammation of the thin sac-like membrane surrounding your heart (pericardium). This condition may be caused by insufficient dialysis or other reasons. The inflammation causes fluid to build up around your heart and interferes with your heart's ability to pump blood to the rest of your body.

High potassium levels (hyperkalemia)
Your dietitian will recommend a diet that's low in potassium because high-potassium foods can raise your potassium level. A very high level of potassium can cause your heart to stop.

Nerve damage (peripheral neuropathy)
If you develop peripheral neuropathy, you will develop nerve damage in your legs, feet or hands. High levels of waste products in your body, diabetes, vitamin B-12 deficiencies or other diseases may be the cause.

Infection
People receiving hemodialysis can develop problems with their venous access site, such as blockage from blood clotting and poor blood flow. But the most serious problem at the venous access site is infection. About 15 percent to 20 percent of deaths among people receiving hemodialysis are due to infections, most of which are related to the venous access site.

People on peritoneal dialysis are also at high risk of peritonitis, an infection of the peritoneum and abdominal cavity. If you receive peritoneal dialysis, your health care team will teach you how to keep your peritoneal catheter free of bacteria to help you avoid peritonitis.

Other complications
Other difficulties connected with dialysis include sleep disorders, anxiety and depression. You and your health care team will work together to find solutions for these problems if you develop them.
How to prevent complications associated with dialysis

As the most important member of your health care team, you'll be the star player when it comes to preventing or correcting problems that can lead to long-term and even life-threatening complications. You can help prevent complications by:

- Taking preventive action to avoid infection, such as practicing good hygiene at your venous access site for hemodialysis, or your peritoneal catheter for peritoneal dialysis
- Following the meal plan your doctor and dietitian recommend
- Sticking to the amount of fluid your doctor wants you to drink each day
- Taking the medications your doctor prescribes
- Having hemodialysis or peritoneal dialysis at a center or in your home according to your doctor's treatment plan
- Keeping your health care team informed about any signs or symptoms of complications you experience