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Editorial on Side effects of Dialysis to Kidney Patients

Alexander V Pechersky 

Dialysis is a lifesaving treatment for those with end stage renal disease (ESRD). However, with both peritoneal dialysis (PD) and hemodialysis (HD), there are occasions when a patient may have side effects from the treatment.These side effects can be mild or severe, depending on the patient’s condition and whether or not they’re following their dietary and fluid restrictions. Most of these side effects can be managed if the patient carefully follows their healthcare team’s dietary and fluid intake recommendations. A hernia is a potential side effect of PD, a type of home dialysis treatment. The muscles of the abdominal wall protect the internal organs and keep them in place. The insertion of a catheter—positioned inside and outside of the body to allow dialysis solution into and out of the abdominal cavity—can weaken these muscles. When patients do an exchange (the process of filling, dwelling and draining dialysis solution), the pressure from the dialysis solution in the peritoneum pushes against these already weak muscles. This pressure could cause a tear, and organs from the abdominal cavity could emerge through the opening. Surgery is the only way to repair a hernia. Some PD patients find eating uncomfortable because of the full feeling from the dialysis solution in their stomach area. Although eating less feels better, it can lead to malnutrition. The PD renal diet is designed to meet patients’ nutritional needs. Timing exchanges (generally after meals) helps relieve some of the discomfort.

Symptoms related to restless leg syndrome (RLS) can also be experienced by people receiving dialysis. People with RLS keep moving their legs because the leg nerves and muscles create uncomfortable sensations such as crawly, prickly or itchy feelings. RLS usually happens while sitting or lying down and can disrupt sleep. RLS can have multiple causes, such as some forms of kidney disease, uremia, iron deficiency, or neuropathy (nerve damage). Therefore, it’s important to speak to your healthcare team for a diagnosis and a prescription which will help address the specific cause.

Muscle cramping can cause discomfort for people receiving dialysis. The exact cause is unknown, but it is believed to have something to do with fluid removal toward the end of a dialysis session. Treatment might include stretching the cramped muscle, applying hot packs to the affected area to help increase circulation, or certain medications that can provide relief. Speak with your healthcare team if you experience muscle cramping, so they can look into a possible cause and recommend the right treatments for you. Monitoring fluid intake to avoid large fluid gains between dialysis treatments might also help.

Symptoms related to low blood pressure can include dizziness, lightheadedness or fatigue. Low blood pressure can have different causes, including excess fluid weight between sessions and having a weak heart. You should be aware of these symptoms, and let your healthcare team know if you are experiencing any of these symptoms. Your healthcare team might adjust your dialyzing time or frequency, and recommend restrictions of fluid intake. Salty foods that can increase thirst should also be avoided.