Dialysis (hemodialysis or peritoneal dialysis) is a life-sustaining procedure for individuals with end-stage renal disease (ESRD). When the kidneys fail, the body loses its natural ability to filter blood, making regular treatment non-negotiable for survival. Adherence to the prescribed schedule is paramount, as even a single missed session can lead to severe, life-threatening complications. The scheduled frequency of treatment is carefully calculated to manage the daily accumulation of fluid and toxins that the body can no longer process naturally.
The Critical Function of Dialysis
Dialysis is designed to temporarily replace the three primary functions of healthy kidneys. It removes metabolic waste products, such as urea and creatinine, which are toxic when they build up in the bloodstream. These waste compounds are transferred out of the blood and into a specialized solution called dialysate through a process known as diffusion.
The procedure also maintains the balance of electrolytes, especially sodium, calcium, and bicarbonate, which regulate nerve and muscle function. Dialysis actively prevents the dangerous elevation of potassium, an electrolyte that can quickly disrupt heart rhythm. Furthermore, dialysis controls the total fluid volume in the body by removing excess water that the patient cannot excrete as urine. This fluid control is important for managing blood pressure and preventing strain on the heart and lungs.
Acute Physiological Dangers of Skipping Treatment
Missing even one dialysis session allows for the immediate accumulation of fluid and solutes, leading to medical emergencies. One of the most immediate threats is fluid overload. Without the fluid removal process, excess water rapidly builds up in the body’s tissues, causing swelling in the extremities and a sharp rise in blood pressure.
This fluid accumulation strains the cardiovascular system and can quickly lead to pulmonary edema, where the fluid backs up into the lungs. Symptoms include severe shortness of breath, a wet cough, and a feeling of drowning. The other urgent danger is hyperkalemia, a dangerously high level of potassium in the blood. Elevated potassium can interfere with the electrical signals that regulate the heartbeat.
This disruption can cause severe cardiac arrhythmias, which are irregular heart rhythms that may result in sudden cardiac arrest and death. Finally, the continued buildup of waste products leads to uremia, a toxic condition that affects multiple organ systems. Symptoms of worsening uremia include fatigue, nausea, vomiting, and confusion.
Emergency Protocol After Missing a Session
The first action after missing a session is to immediately contact the dialysis clinic or the patient’s kidney care team. This should be done regardless of the time of day, as the medical team needs to assess the patient’s condition and arrange an urgent make-up treatment. The clinic staff will inquire about the patient’s symptoms and help determine the safest next steps.
Patients and caregivers must be vigilant for specific warning signs that necessitate an immediate trip to the nearest Emergency Department. Waiting for the next scheduled appointment when experiencing these symptoms can be fatal. Urgent symptoms include:
- Severe, sudden shortness of breath
- Chest pain
- An irregular or pounding heartbeat
- Any sudden change in mental status like confusion
The care team will typically schedule a “catch-up” treatment, which is often an extended session designed to safely remove the accumulated fluid and toxins. Removing a large amount of fluid rapidly can cause side effects such as cramping, headaches, or low blood pressure during the session. Until the make-up session can occur, patients must strictly adhere to emergency dietary restrictions, especially limits on fluid and high-potassium foods.