What are the tremendous effects after starting dialysis for Impaired renal function?

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Last updated: April 2, 2025 • View editorial policy

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From the Guidelines

Tremors after starting dialysis are likely due to electrolyte imbalances, particularly low calcium levels, and should be managed by checking serum calcium, phosphorus, and parathyroid hormone levels immediately, as recommended by the most recent guidelines 1. To address tremors after starting dialysis, it is essential to consider the underlying causes, which may include electrolyte imbalances, uremic neuropathy, medication side effects, or dialysis disequilibrium syndrome.

  • The 2024 KDIGO clinical practice guideline for the evaluation and management of chronic kidney disease 1 emphasizes the importance of initiating dialysis based on a composite assessment of a person’s symptoms, signs, quality of life, preferences, level of GFR, and laboratory abnormalities.
  • According to the guideline, dialysis should be initiated if the presence of one or more symptoms or signs attributable to kidney failure is evident, such as neurological signs and symptoms attributable to uremia 1.
  • In terms of management, oral calcium supplementation (calcium carbonate 1000-1500 mg daily) should be initiated, along with vitamin D supplementation (calcitriol 0.25-0.5 mcg daily) to improve calcium absorption, and the dialysate calcium concentration should be ensured to be appropriate (typically 2.5-3.0 mEq/L) during dialysis sessions.
  • Other potential causes, such as uremic neuropathy, medication side effects, or dialysis disequilibrium syndrome, should also be considered and addressed accordingly, with adjusting the dialysis prescription by slowing blood flow rates or shortening initial sessions potentially helping to reduce symptoms if disequilibrium is suspected.
  • Regular monitoring of electrolytes before and after dialysis sessions is essential for proper management, as emphasized by the guideline 1.

From the Research

Tremendous After Starting Dialysis

  • The term "tremendous" is not clearly defined in the context of dialysis, but it can be inferred that it refers to significant or severe symptoms experienced by patients after starting dialysis.
  • According to the study 2, dialysis disequilibrium syndrome (DDS) is a clinical constellation of neurologic symptoms and signs occurring during or shortly following dialysis, especially when dialysis is first initiated.
  • The study 2 also states that DDS is associated with mortality but is also preventable, and identification of patients at risk, preventive measures, early recognition, and prompt management of DDS will minimize morbidity and mortality associated with this syndrome.
  • Other studies 3, 4, 5, 6 do not directly address the term "tremendous" in the context of dialysis, but they provide information on the complications and management of dialysis, including hypotension, cardiovascular complications, and the use of antihypertensive medications.

Complications of Dialysis

  • The study 4 reports that cardiovascular complications, such as arrhythmias and cardiac arrest, and infection-related complications are common in patients undergoing maintenance dialysis.
  • The study 5 found that certain antihypertensive medications, such as β and α–β blockers, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, and diuretics, may increase the risk of intradialytic hypotension compared to calcium channel blockers.
  • The study 6 highlights the challenges of managing hypertension in dialysis patients, including the need for accurate blood pressure measurements and the lack of outcomes-based evidence to guide management decisions.

Management of Dialysis

  • The study 2 emphasizes the importance of preventive measures, early recognition, and prompt management of DDS to minimize morbidity and mortality associated with this syndrome.
  • The study 3 reviews the indications for initiation of renal replacement therapy, as well as dosing and technical aspects in the management of continuous renal replacement therapy (CRRT).
  • The study 4 suggests that patient-clinician shared decision-making should help determine when to initiate dialysis, and that the timing of therapy initiation should be informed by persistent signs and symptoms of uremia and volume overload, worsening eGFR, metabolic acidosis, and hyperkalemia.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Research

Dialysis disequilibrium syndrome prevention and management.

International journal of nephrology and renovascular disease, 2019

5
Research

Antihypertensive Drug Treatment and the Risk for Intrahemodialysis Hypotension.

Clinical journal of the American Society of Nephrology : CJASN, 2024

6
Research

Antihypertensive Agents in the Dialysis Patient.

Current hypertension reports, 2019

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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