The hemodialysis treatments you are receiving replace only a small part (less than 15 percent) of the normal function of your kidneys. If you don’t get enough of the treatment your blood will retain too much of the body’s waste products that cause uremia and you will always feel sick. If you are being underdialyzed you can expect to experience many of the following symptoms: chronic weakness and tiredness; real weightloss; poor appetite; nausea; a taste of ammonia in your mouth; feeling better after treatment than before; yellow skin color; and uremic pericarditis (inflammation of the heart). You will also be at higher risk for infections and prolonged bleeding.

It is also important to recognize that in some cases patients can be underdialyzed without experiencing the most severe complications of uremia. Lesser symptoms are often easily overlooked or denied. But loss of real body weight or failure to gain back your normal weight should cause worry. A loss of real weight can be covered up by replacement with water weight. You will know this is happening when post-dialysis weight is unchanged and your blood pressure is getting higher; you get tired more easily when walking or climbing; and you get water in your lungs (pulmonary edema) after gaining the same amount of water weight you used to gain without problems.

 On the other hand, patients who are well-dialyzed will experience the following: a sense of feeling good; good appetite with more normal weight; feeling like dialysis is not necessary when treatment is due (except for the need to remove fluid); and “you’ll wonder where the yellow went.” A well-dialyzed patient should be able to look ahead to doing many of the things that were planned before renal disease occurred.