Long-Term Effects of Dialysis on Kidney Failure Patients

When kidneys fail, waste products and extra fluid build up in the body. Dialysis removes these substances from the blood and helps keep you healthy.

Hemodialysis may cause side effects. For example, hemodialysis can lower your blood pressure and make you feel dizzy or lightheaded. It can also cause muscle cramps from losing too much fluid during treatment.

Cardiovascular Complications

A lifesaving treatment, dialysis has several potential side effects, including heart complications. Hemodialysis, which involves creating an artificial access point in the body (a fistula or graft), can cause infections, bleeding and the formation of blood clots. The presence of a clot increases the risk of heart attack and death.

Hemodialysis also decreases blood flow to the brain, which can lead to memory loss and verbal learning problems, according to a study published in 2016. The research found that patients with a kidney transplant who were able to stop dialysis saw improvements in these areas of their brain function.

Hemodialysis can increase the chance of arrhythmias, such as atrial fibrillation (AFi). This may be due to rapid hydroelectrolytic and acid-base changes in the dialysate, high sodium and potassium concentrations, and a prolonged QT interval caused by the use of diuretics. It is important that dialysis patients take antiarrhythmic medications, such as angiotensin converting enzyme inhibitors, to help prevent these conditions.

Dialysis-Related Amyloidosis

Amyloidosis is a disorder in which fragments or whole proteins are deposited extracellularly as abnormal, insoluble fibrils. Amyloidosis can involve any organ system, but it most often affects the kidneys. The amyloid deposits can lead to progressive organ failure and death.

Dialysis-related amyloidosis (DRA) is a serious complication of long-term hemodialysis and peritoneal dialysis. It is characterized by the deposition of amyloid fibrils, principally composed of beta2-microglobulins (b2M), in the osteoarticular structures and viscera. The b2M is cleared by glomerular filtration and proximal tubular reabsorption and catabolism, but these processes are impaired in people with ESRD.

Typically, a kidney biopsy is the method by which DRA is diagnosed. The kidney biopsy shows characteristic lesions that resemble those of light-chain amyloidosis (AL) and some of the hereditary familial amyloidoses. Currently, no effective treatment is available for DRA, but high-flux dialysis membranes have been shown to reduce beta2-microglobulin levels in dialysis patients.

Bone and Mineral Disorders

Kidney disease can affect your body’s bones, causing them to become weak. Hemodialysis can also damage your bones by removing too much calcium and making it harder for you to absorb vitamin D, which helps keep your bones strong.

During dialysis, you sit or recline in a chair while your blood flows through a machine called the dialyzer (di-AL-zer). The blood is removed through a needle in a large blood vessel — usually in your arm or leg — and is run through the machine to clean it of waste and extra fluid. The cleaned blood is then returned to your body.

Hemodialysis can cause complications such as low blood flow to your brain, which can lead to memory loss and other symptoms. Hemodialysis may also lower your energy levels and make you feel tired. You can help prevent these problems by learning about the effects of dialysis, adjusting your diet and taking medicine.

Infection Risk

People on dialysis are at high risk of infection. Infections can affect any organ in the body, and many people with kidney disease also have other health problems that make them more susceptible to infections.

The type of dialysis you have can impact your risk of infection. Hemodialysis is most common, but peritoneal dialysis can be an option as well.

Hemodialysis involves removing and replacing fluid in your body several times each day. Your kidney doctor (nephrologist) will prescribe a treatment schedule that is best for your health needs. You can help reduce your risk of infection by following the treatment schedule as prescribed and reporting any symptoms to your team. Some hemodialysis side effects include muscle cramps, itchy skin, changes in blood sugar or potassium levels, and weight gain.

Hematologic Changes

In hemodialysis, the blood is removed from the body and pumped through an external circuit for filtration. This process reduces blood flow to the brain, and researchers have found that people on dialysis can develop cognitive problems as a result.

Fluid overload is common in people on hemodialysis, and if not managed properly can lead to life-threatening complications such as heart failure or fluid accumulation in the lungs (pulmonary edema). A condition known as ‘dialysis disequilibrium syndrome’ is characterized by headaches, nausea, clammy skin and fatigue.

Both hemodialysis and peritoneal dialysis can cause fatigue, but regular exercise may help improve energy levels. Fatigue can be caused by many things, including diet and comorbid diseases. Talking with your doctor or dietitian can help identify ways to improve energy levels.

Psychosocial Impact

When kidney function declines to the point of not being able to eliminate waste and unwanted water, dialysis becomes necessary. This process uses artificial kidneys (a machine known as a dialyzer) to perform the kidney’s natural functions of eliminating waste and regulating water and mineral balance in the body.

For many patients who initiate hemodialysis, it can take time to accept that their new treatment is a lifelong therapy. It is a major life change that affects many aspects of their lives, including relationships and their ability to work. Emotional stressors include denial, loss of independence, financial strain, food and fluid restrictions, emotional trauma, physical dysfunction, sleep disturbances and changes in identity.

Studies indicate that nephrology social workers’ involvement can improve adjustment to illness and increase QoL by addressing psychological distress and emotional needs. It is important to identify these issues early and to provide supportive counselling throughout the kidney failure disease trajectory, although this may be most effective during the pre-KRT phase (Auslander & Dobrof, 2001). Psychoeducation is a key component of this intervention.