Answer: There are several reasons why patients may feel nauseated and dizzy after a hemodialysis treatment. For some patients this hardly ever happens. For others this may not be all that uncommon. Feeling nauseated and dizzy after dialysis can make a person not want to have another dialysis treatment. If a person starts skipping dialysis it can be even more dangerous and they will become more ill. When nausea and dizziness do happen it tends to get better in a few hours and definitely by the next day. If it does not improve it may be a sign of another problem. First, it is important to let the nurse or doctor know that you are having this problem. Some patients feel they should not complain or that feeling bad after dialysis is normal. Let the dialysis team know what you are feeling. Many times they can make certain adjustments that can dramatically improve your quality of life. Sometimes medications can help. The most important thing to do is to find out the cause and correct it. Below are some of the more common causes of nausea and dizziness.

Hypotension or low blood pressure from gaining too much weight between dialysis treatments

A common cause of nausea, dizziness and that tired feeling comes from gaining too much weight between dialysis treatments. Between dialysis treatments fluid accumulates from eating and drinking. This happens over two days. It is the job of the dialysis treatment to remove all of that fluid in about four hours. This is not normal for the body. The more fluid that has to be removed the greater the chance of hypotension or low blood pressure. This can cause nausea and dizziness during or after a dialysis treatment. The more fluid a person gains between dialysis means the more fluid that has to be removed during dialysis. The newer machines have small computers inside that help the dialysis machine remove fluid evenly over the dialysis treatment. Each person is different and some people get sicker more easily than others after a dialysis treatment. Pay attention to your body and you will be able to tell what your body can tolerate and help keep yourself feeling well most of the time.

Blood pressure medications

Many patients on dialysis have high blood pressure. Usually the blood pressure falls during the dialysis treatment so most patients are recommended to not take their blood pressure medications before dialysis. This is because if the medicine starts working and the dialysis machine is removing fluid at the same time, the blood pressure may go too low. Then you will start to feel sick, nauseated and dizzy. Some people have very high blood pressures and need to take medicine before dialysis. Most people should not. Make sure to let your doctor know if you are taking your blood pressure medicines before dialysis and feeling sick during or at the end of a treatment.

Other causes of nausea and dizziness include having an allergic reaction to the dialyzer or being sick from an infection. Also, like everything else in life there may always be other reasons for things to happen. There may be reasons we do not even know of yet. Most importantly, let the dialysis team know what is happening so they can check into the problem. With teamwork the cause can usually be determined and the problem solved or greatly improved.

Answer provided by Keith Norris, MD, who is a faculty member in the Department of Internal Medicine and the Associate Dean for Research at Charles R. Drew University in Los Angeles. Dr. Norris is a member of the AAKP Medical Advisory Board.

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, May 2003 Volume 18 Number 6. 

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