Dialysis Side Effects & Safety

Most side effects are manageable once you know the pattern and speak up early. This page covers common issues during and after in-center hemodialysis and simple ways to reduce them.

Common during or after treatment

Low blood pressure (light-headed, woozy, cold sweat):
- Now: tell staff; they can lower fluid removal, recline you, give fluids, and warm you.
- Next time: arrive close to your dry weight, spread fluids/salt between runs, ask about a slower or longer session, and med timing (BP pills may need adjusting).
Muscle cramps (legs, feet, hands):
- Now: slow fluid removal, gentle stretches, warmth; small saline per clinic policy.
- Next time: smaller fluid gains, review dry weight and session length, warm the access arm, ask about magnesium/potassium levels if frequent.
Headache or nausea:
- Now: anti-nausea meds, slower fluid removal, snacks if allowed.
- Next time: steadier fluid/salt between runs; ask about dialysate settings, cool dialysate, or med timing.
“Dialysis hangover” (fatigue/fog after):
- Now: hydrate as directed, light snack, planned rest window.
- Next time: discuss longer/slower sessions, dry-weight tweaks, and anemia management.
Itchy skin:
- Now: fragrance-free moisturizer; avoid hot showers.
- Next time: ask about phosphorus control, binders, and other causes (dryness, allergies).
Restless legs or trouble sleeping:
- Short walks, calf stretches, limit caffeine late; ask about iron and other contributors.

Needles & access issues

Sore or bruised sites: normal early on; rotate sites (rope-ladder) or ask about buttonhole policy.
Infiltration (needle slips, swelling/bruise):
- Now: stop the treatment at that site; cold pack first 24 hours, then warm compresses.
- Next time: review needle angle/technique and site selection.
Bleeding after needles out: hold steady pressure; don’t peek. If bleeding won’t stop after ~20 minutes, tell staff.
Fistula/graft changes: loss of the thrill vibration, new whistling sound, swelling, red/tender spots—report promptly.
Catheters: keep dressing clean/dry, don’t tug or get it wet; fever or chills can mean infection—call now.

Infection prevention (simple habits)

Clean hands before treatment; keep access skin clean and dry between sessions.
Don’t scratch scabs; avoid tight clothes/pressure on the access.
Report fever, chills, spreading redness, pus, foul odor, or new pain along the access path.

Medicines that can drive symptoms

Blood-pressure meds: timing may need changes to avoid lows during treatment.
Phosphate binders: can cause constipation or nausea—tell your team.
New prescriptions: always inform the dialysis team; some drugs affect blood pressure, potassium, or bleeding.

When to call (don’t wait)

Call the clinic now: fever or chills, new redness/pus at access, bleeding that won’t stop, severe cramps, chest pain or new shortness of breath, sudden loss of fistula/graft thrill.
ER/911: severe trouble breathing, chest pain that doesn’t ease, confusion, or you pass out.

Questions to ask: What’s my current dry-weight goal? How can we tweak time/ultrafiltration to reduce cramps or low BP? Which symptoms mean “call now,” and who answers after hours?

Educational only. Your dialysis team will tailor prevention and treatment to you.