Both haemodialysis and peritoneal dialysis cause side effects. This is due to the way that dialysis is carried out and the fact that dialysis can only compensate for the loss of kidney function to a certain extent.
Fatigue
Fatigue, where you feel tired and exhausted all the time, is a common side effect in people who have used both haemodialysis and peritoneal dialysis on a long-term basis. Fatigue is thought to be caused by a combination of:
- the loss of normal kidney function
- the effects that dialysis can have on the body
- the dietary restrictions associated with dialysis
- the overall stress and anxiety that many people with kidney failure experience
There are several treatment options that may be of some use in helping to improve the symptoms of fatigue.
Firstly, you may want to consult your dietitian because your diet may need to be adjusted in order to boost your energy levels. Secondly, research has shown that regular aerobic exercise can improve the symptoms of fatigue.
It can be challenging to start a programme of regular exercise if you are fatigued and many people who are on dialysis complain of feeling out of breath. However, if you persevere with regular exercise, it should become easier with time. Low-to-moderate aerobic exercise is recommended such as:
- cycling
- jogging
- walking
- swimming
Your dialysis care team or your GP can advise you about the type of exercise that is most suitable for you.
Haemodialysis
Low blood pressure
Low blood pressure (hypotension) is one of the most common side effects of haemodialysis. It can be caused by the drop in fluid levels that occurs during dialysis. Low blood pressure can cause nausea and dizziness.
The best way to minimise the symptoms of low blood pressure is to ensure that you keep to your daily fluid intake recommendations. If symptoms of low blood pressure persist, you should consult your dialysis care team because the amount of fluid used during dialysis may need to be adjusted.
Invasive staphylococcal infections
People having haemodialysis have an increased risk of developing an invasive staphylococcal infection. These infections are caused by staphylococcus aureus bacteria. This type of bacteria are usually responsible for minor skin infections such as boils.
However, the haemodialysis process can allow the bacteria to enter the body where they can cause a more serious invasive infection that can spread through the blood, leading to multiple organ failure. This is known as sepsis or blood poisoning.
Sepsis that is associated with an invasive staphylococcus infection is the second most common cause of death, after heart disease, in people having haemodialysis.
The first symptoms of an invasive staphylococcal infection include:
- a high temperature (fever) of 38C (100.4F) or above
- dizziness, which is related to a decrease in blood pressure, or a worsening of low blood pressure if you already have it
If you have a high temperature, you should contact your dialysis unit immediately for advice. If this is not possible, call NHS Direct on 0845 46 47 or your local out-of-hours service.
If you develop an invasive infection, you will need to be admitted to hospital and treated with injections of antibiotics.
Read more about treating staphylococcal infections.
Muscle cramps
During a haemodialysis session, some people experience muscle cramps, usually in their lower legs. This is thought to be caused by the muscles reacting to the fluid loss that occurs during haemodialysis.
You should consult your dialysis care team if you have muscle cramps that become particularly painful. Medication may be available that can help you to cope better with the symptoms.
Itchy skin
Many people who receive haemodialysis experience itchy skin. This is thought to be due to a build-up of potassium in the body. Avoiding potassium-rich food can help reduce the frequency and severity of this symptom. Some people have also found that using moisturising cream can minimise the discomfort caused by itching.
Other side effects
Other side effects of haemodialysis include:
- difficulties falling asleep (insomnia) or staying asleep
- bone and joint pain
- lack of interest in sex (decreased libido)
- dry mouth
- anxiety
Peritoneal dialysis
Peritonitis
A common side effect of peritoneal dialysis is that the peritoneum becomes infected with bacteria (peritonitis). Peritonitis can occur if the dialysis equipment is not kept properly sterilised (free of germs). If bacteria is present on the equipment it can be passed into the peritoneum.
Lack of appetite and nausea are the initial symptoms of peritonitis. These are quickly followed by abdominal pain, which usually begins as a dull ache in your abdomen before progressing to a steady, severe pain.
Other symptoms of peritonitis include:
- being sick
- chills (episodes of shivering and cold)
- a high temperature (fever) of 38C (100.4F) or above
- rapid heartbeat (tachycardia)
- feeling thirsty
- not passing any urine, or passing much less than normal
Peritonitis is treated with injections of antibiotics (intravenous antibiotics). The antibiotics are usually injected directly into the tissue of the peritoneum.
The most effective way to prevent peritonitis is to keep your dialysis equipment clean. You will be given training in how to do this. If you have repeated episodes of peritonitis, it may be that you are not a suitable candidate for peritoneal dialysis and you should change to haemodialysis.
Hernia
A hernia occurs when an internal part of your body, such as an organ, pushes through a weakness in the muscle or surrounding tissue wall. People having peritoneal dialysis are at increased risk of developing a hernia because holding fluid inside the peritoneal cavity for many hours places strain on the muscles of the abdomen.
The main symptom of a hernia is the appearance of a lump in your abdomen. The lump may be painless and may only be discovered during a check-up. In some people, certain activities can cause a hernia to become painful. These include:
- bending over
- lifting heavy objects
- coughing
- having sex
Surgery is usually needed to repair a hernia. During surgery, the surgeon will place the protruding intestine or tissue back inside your abdominal wall. The muscles of the abdominal wall will be strengthened using a synthetic mesh.
Weight gain
The dialysate fluid that is used during peritoneal dialysis contains sugar molecules, some of which are absorbed into your body. This can increase your daily calorie consumption by up to several hundred calories a day.
If you do not compensate for these extra calories by reducing the amount of calories that you eat and by taking regular exercise, it is likely that you will experience weight gain. In a minority of cases, the weight gain can be excessive.
One study found that around 7% of people having peritoneal dialysis will gain around 10kg (two stone) over the course of two years.
If you are concerned that you're gaining too much weight, you should talk to your dialysis team who can recommend a diet and exercise plan that can help you lose weight.
Avoid using fad diets that claim to be able to help you lose a lot of weight quickly. This type of extreme dieting could upset your body’s chemistry and make you feel very ill.
