Answer: When hemodialysis patients are asked if dialysis hurts, the answer is usually “No, except for when the needles are put in and sometimes when the needles are taken out.” We will return to the dialysis needles later.

Other episodes of pain during hemodialysis are infrequent. Once in awhile a patient on dialysis will have muscle cramps, usually associated with large amounts of fluid removal. The cramps can be briefly uncomfortable, though fortunately are promptly alleviated with adjustments in the dialysis treatment. In most patients, cramps can be avoided by drinking less fluid between dialysis treatments. Patients may also sometimes express discomfort from having to sit for the full length of the treatment, though this is really perceived as a restlessness or boredom, and not painful. Some patients have pain for reasons unrelated to dialysis. Their pain may continue through the dialysis treatment, though not caused by dialysis.

The hemodialysis treatment is not painful and is usually uneventful. Patients pass their time on dialysis by watching television or DVDs, reading, writing, sleeping, listening to radios and music and talking with neighbor patients on dialysis or with the healthcare staff. Some patients get involved in puzzle books, use a laptop computer or just take the time to drift off into their private thoughts. Many patients find the treatments to be boring and slow, others find that the time passes without too much difficulty. 

Now back to the dialysis needles. At the start of each dialysis treatment, patients need to have two dialysis needles placed into their dialysis fistula, graft or dialysis catheter. Each needle is connected to tubing that allows the patient’s blood to go from the patient to the dialysis machine and then back to the patient. The blood goes from the patient, through the first needle into the tubing to the dialysis machine, through the dialysis machine, continues through the tubing, back to the patient through a second needle which returns the blood to the patient. It is one big loop from patient to dialysis machine back to the patient. The needles are necessary to allow the blood to get from the patient to the dialysis machine without the blood cells being broken or damaged in the process.

If a patient has a dialysis catheter instead of a fistula or graft, then the connection from the patient is made through the catheter to the tubing, to the dialysis machine and back to the other side of the catheter. In this case, the patient does not have any needles placed with the dialysis treatment. This would seem like an excellent way of avoiding the discomfort of the needle placements. However, dialysis catheters cause other problems and are considered the third choice after a native vessel fistula or a synthetic implanted graft. Dialysis catheters have too many infections, lead to a less effective dialysis, can get blocked and can damage blood vessels. In addition, they do not last nearly as long as a good fistula or graft.

Occasionally patients will try a numbing medicine for the skin, called a topical anesthetic, at the site where a needle will be placed. Some anesthetics are available as a spray. These can be effective, though are often rather expensive. Some skin anesthetics are given by a small injection. Patients usually do not find it worthwhile getting a needle stick for the anesthetic to avoid the pain from the dialysis needle.

Most patients usually find a coping mechanism that works best for them for the brief though noticeable pains of the needle sticks at the start of dialysis and the lesser discomfort as the needles are removed at the end of dialysis. The pain seems to diminish after being on dialysis for months, the skin may be slightly calloused and less sensitive or patients may just become adjusted and not notice.

Answer provided by Jim Weiss, MD. Dr. Weiss is president of the Renal Physicians Association (RPA) and is a practicing nephrologist in Monroeville, Pennsylvania.

The Dear Doctor column provides readers with an opportunity to submit renal related health questions to healthcare professionals who specialize in the area of concern. The answers are not to be construed as a diagnosis and therefore, altercations in current healthcare should not occur until the patient's physician is consulted.

This article originally appeared in aakpRENALIFE, September 2003 Volume 19 Number 2. 

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