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Managing complications

People with advanced kidney disease can sometimes develop medical problems as a result of their illness or as a complication of their treatment.

These can be divided into several categories:

Heart and circulatory issues

The complicated interdependency between our heart and kidneys means that kidney disease can be both a cause and symptom of cardiovascular disease and high blood pressure (hypertension).

Blood cell deficiencies

Our kidneys secrete a hormone called erythropoietin (EPO). This controls the production of red blood cells in the bone marrow. When kidney function diminishes, insufficient hormone is produced and the number of red blood cells being produced falls, resulting in anaemia.

Mineral imbalances and bone disease

Reduced kidney function can upset the balance of mineral levels in our bodies and create problems when minerals levels in the blood get too high or too low:

  • Too much potassium in the blood is known as hyperkalaemia
  • Too much phosphorus in the blood is known as hyperphosphatemia
  • Too little calcium in the blood is known as hypocalcaemia.
  • Too much calcium in the blood is known as hypercalcaemia[CT2]

Secondary hyperparathyroidism is a condition characterised by the overproduction of parathyroid hormone (PTH) – a chemical messenger, produced by the parathyroid glands to control calcium and phosphate levels in our blood and calcium levels in our bones. This occurs as a direct result of chronic kidney disease (CKD).

People with advanced CKD can develop bone disease where, without treatment, bones can get weaker and thinner, becoming painful or breaking more easily. Bone disease occurs because the kidneys can no longer regulate calcium and phosphorus levels in the body and also lose their ability to activate’ Vitamin D (so less calcium is absorbed from food).

Bone disease can affect anyone with advanced kidney disease (especially people on dialysis) and it can sometimes be a problem for people who have had a kidney transplant.


Acid imbalances

Normal metabolism generates acid, particularly if the diet contains a lot of animal protein. Normal kidneys regulate the acidity of the blood very efficiently. However, reduced kidney function can result in the kidneys being unable to excrete acids into the urine. This causes the blood to become acidic – creating a condition called acidosis.


Infections can sometimes pose a problem for people on dialysis and for people who have had a kidney transplant. They can normally be treated with a simple course of antibiotics but if you develop a serious infection you may need to spend some time in hospital.


People on haemodialysis can sometimes get infections around the area where dialysis needles are inserted into the fistula (a large, strong blood vessel, specially adapted to make it easier to transfer blood to and from the dialysis machine). Infections can also occur in AV grafts or tunneling lines (where a piece of tubing is used to connect an artery to a vein).

If bacteria enter the body and spread through the blood it can cause sepsis (blood poisoning) which, in severe cases, can potentially lead to multiple organ failure. Vascular access infections can also spread to other parts of the body, including the heart valves and the discs between vertebrae.


Peritoneal dialysis

People on peritoneal dialysis can generally avoid infections by dialysing in a clean area, keeping dialysis equipment clean and following dialysis procedure instructions given by their dialysis nurse. However, sometimes the peritoneal membrane (or peritoneum) – which is used to remove waste products and excess fluid from the blood in this form of dialysis – can become infected. This is called peritonitis.

Kidney transplantation

People are more prone to infection after a kidney transplant because their anti-rejection immunosuppressive drugs partially suppress their immune systems. Transplant patients may be more prone to common viral and bacterial infections, such as colds, flu, and urine infections; but they are also more prone to infections that are only rarely seen in patients with normal immunity. These rare infections can be difficult to diagnose and treat.

Nerve damage

Help for you

People with advanced kidney disease can sometimes experience nerve damage.

  • As a complication of diabetes – which is now the leading cause of kidney failure in the UK
  • Due to a build-up of toxins in the blood[CT3]

This can cause a range of symptoms including numbness and tingling (especially in the feet), muscle twitching, muscle weakness and pain.

If you experience any of these problems your kidney doctors and nurses will be able to help you by:

  • Giving you medicines
  • Possibly suggesting dietary changes for some conditions
  • Possibly putting you on dialysis or adjusting your dialysis treatments
  • Offering other treatments (which may include surgery for some issues)

So if you think you have a problem or are concerned about any possible complications don’t hesitate to speak to your kidney doctor, nurse or GP.

Reviewed April 2019

Need for more research

More research is needed into how best to prevent each of the complications listed here.

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