Breathing problems in dialysis patients should not be ignored.
People receiving dialysis may experience shortness of breath, chest heaviness, difficulty breathing while lying down or breathlessness during or after a dialysis session. These symptoms can have several possible causes, and some require urgent medical attention.
One common reason is excess fluid accumulation when the kidneys cannot remove enough water from the body. Fluid can build up in the lungs or around them and make breathing difficult.
However, breathlessness is not always caused by fluid overload. It can also occur because of anemia, heart disease, infection, electrolyte abnormalities, low blood pressure during dialysis, lung disease or other medical problems.
At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides individualized evaluation and management for patients with kidney failure, dialysis-related complications and associated medical conditions.
Common Causes of Breathing Problems in Dialysis Patients
1. Fluid Overload
Fluid overload is one of the most important causes of breathlessness in advanced kidney failure.
When kidney function is severely reduced, the body may retain water and sodium.
This can lead to:
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Swelling of the feet
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Rapid weight gain
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High blood pressure
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Breathlessness
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Difficulty lying flat
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Fluid accumulation in or around the lungs
Dialysis removes excess fluid, but the amount that can safely be removed during one session is limited.
If a patient regularly gains significant fluid between dialysis sessions, managing fluid and sodium intake becomes particularly important.
2. Pulmonary Edema
In severe fluid overload, fluid can accumulate inside the lungs, a condition known as pulmonary edema.
Symptoms may include:
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Sudden severe breathlessness
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Difficulty lying down
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Cough
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A feeling of suffocation
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Rapid breathing
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Severe anxiety associated with difficulty breathing
Pulmonary edema can be life-threatening and requires urgent medical assessment.
3. Heart Problems
Heart disease is common among people with advanced kidney disease.
Conditions such as:
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Heart failure
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Coronary artery disease
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Abnormal heart rhythms
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Cardiomyopathy
can contribute to breathlessness.
A patient who becomes breathless despite apparently adequate dialysis may need evaluation for an underlying cardiac condition.
4. Anemia
Kidney failure can reduce the production of erythropoietin, a hormone involved in red blood cell production.
As a result, some dialysis patients develop anemia.
Anemia may cause:
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Tiredness
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Weakness
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Reduced exercise tolerance
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Dizziness
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Shortness of breath, particularly with activity
Blood tests can help determine whether anemia is contributing to symptoms.
Treatment depends on the cause and may include iron replacement or other therapies when appropriate.
5. Breathing Problems During Dialysis
Some patients experience breathlessness during a dialysis session.
Possible causes include:
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Excessive fluid removal
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Low blood pressure
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Dialysis-related reactions
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Heart problems
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Electrolyte changes
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Anxiety
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Other acute medical conditions
Breathlessness that develops during dialysis should be reported to the dialysis team immediately.
The treatment team may check blood pressure, oxygen level, heart rate and other parameters to determine the cause.
6. Low Blood Pressure During Dialysis
Dialysis removes fluid from the bloodstream.
If fluid is removed too quickly or the amount of fluid removed is greater than the patient's circulation can tolerate, blood pressure may fall.
Symptoms can include:
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Dizziness
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Weakness
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Nausea
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Muscle cramps
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Breathlessness
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Fainting
The dialysis prescription may need to be reviewed when recurrent episodes occur.
7. Lung Infections
Dialysis patients can also develop respiratory infections unrelated to dialysis itself.
Pneumonia, influenza and other infections may cause:
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Fever
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Cough
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Breathlessness
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Chest discomfort
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Weakness
A new cough or fever accompanied by breathing difficulty should be evaluated promptly.
8. Pleural Effusion
Fluid can sometimes accumulate in the space around the lungs, known as a pleural effusion.
This may cause:
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Shortness of breath
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Chest heaviness
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Reduced exercise tolerance
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Difficulty lying down
The underlying cause needs to be identified before treatment is selected.
9. Electrolyte and Acid-Base Problems
Advanced kidney failure can disturb the body's electrolyte and acid-base balance.
Severe metabolic abnormalities may contribute to:
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Weakness
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Rapid breathing
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Confusion
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Abnormal heart rhythms
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Breathlessness
Blood tests can help identify these abnormalities.
10. Anxiety and Other Causes
Not every episode of breathlessness in a dialysis patient is caused by the kidneys.
Anxiety, deconditioning, lung disease, obesity, medication effects and other conditions may also contribute.
Because dialysis patients often have several medical conditions at the same time, persistent breathlessness should be properly evaluated rather than automatically attributed to kidney failure.
Breathing Problems During or After Dialysis: Does Timing Matter?
Yes.
The timing of symptoms can provide useful information.
Breathlessness Before Dialysis
Breathing difficulty before a dialysis session may occur when excess fluid has accumulated between treatments.
Rapid weight gain and swelling may support the possibility of fluid overload.
Breathlessness During Dialysis
Symptoms developing during dialysis can be associated with fluid removal, low blood pressure or other dialysis-related problems.
The dialysis team should be informed immediately.
Breathlessness After Dialysis
Breathlessness after dialysis may have several causes.
If the patient remains fluid overloaded, inadequate fluid removal may be one possibility. On the other hand, excessive fluid removal can cause low blood pressure and other symptoms.
The dialysis prescription and patient's overall condition may need review.
What Symptoms May Suggest Fluid Overload?
Watch for:
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Rapid increase in body weight
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Swelling of feet or ankles
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Swelling around the face
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Breathlessness when lying flat
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Waking at night because of difficulty breathing
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Increasing blood pressure
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Reduced ability to perform normal activities
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Persistent cough
Patients should follow the fluid and sodium recommendations provided by their kidney-care team.
How Is Breathlessness in a Dialysis Patient Evaluated?
A doctor may assess several factors.
Physical Examination
The doctor may evaluate:
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Blood pressure
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Heart rate
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Respiratory rate
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Oxygen saturation
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Weight
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Swelling
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Lung sounds
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Heart sounds
Blood Tests
Depending on the situation, testing may include:
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Hemoglobin
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Electrolytes
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Bicarbonate
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Kidney-function measurements
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Other tests based on symptoms
Chest Imaging
A chest X-ray or other imaging may be recommended when fluid in the lungs, pleural effusion, pneumonia or another lung condition is suspected.
Heart Evaluation
Depending on symptoms, an ECG or echocardiogram may be appropriate.
Review of Dialysis
The nephrology team may review:
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Dry weight
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Interdialytic weight gain
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Fluid removal rate
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Dialysis adequacy
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Blood-pressure patterns
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Dialysis access
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Medication schedule
This can help identify whether dialysis-related factors are contributing to breathlessness.
What Is the Treatment for Breathing Problems in Dialysis Patients?
Treatment depends entirely on the underlying cause.
If Fluid Overload Is Responsible
Management may involve:
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Appropriate dialysis-based fluid removal
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Sodium restriction
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Individualized fluid management
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Review of dry weight
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Adjustment of the dialysis plan when appropriate
Severe fluid overload may require urgent treatment.
If Anemia Is Responsible
Doctors may evaluate iron status and other causes of anemia.
Treatment can include iron replacement or other anemia therapies when appropriate.
If Heart Failure Is Responsible
Heart failure requires a separate medical assessment and an individualized treatment plan.
Fluid management and dialysis may need to be coordinated with cardiovascular treatment.
If Infection Is Responsible
Appropriate antimicrobial treatment may be required depending on the type and cause of infection.
If Dialysis-Related Low Blood Pressure Is Responsible
The dialysis team may review fluid-removal goals, treatment duration, medication timing and other factors.
Patients should not independently change their dialysis schedule or fluid intake.
Can Drinking More Water Help a Dialysis Patient With Breathlessness?
Usually, a dialysis patient should not automatically drink more water when experiencing breathlessness.
If the breathlessness is caused by fluid overload, additional fluid may make the problem worse.
Fluid intake should be based on the patient's residual urine output, dialysis schedule, weight changes, swelling and medical advice.
If a dialysis patient suddenly develops significant breathing difficulty, seeking medical assessment is more important than attempting to treat the symptom by drinking water.
How Can Dialysis Patients Reduce the Risk of Fluid-Related Breathlessness?
Patients can discuss individualized strategies with their dialysis team.
These may include:
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Following the recommended fluid allowance
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Limiting excess dietary sodium
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Monitoring weight between dialysis sessions
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Taking prescribed medicines correctly
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Attending all scheduled dialysis treatments
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Reporting unusual swelling
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Reporting rapid weight gain
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Following the prescribed dialysis plan
Do not deliberately skip or shorten dialysis sessions without discussing it with the dialysis team.
When Is Breathing Difficulty an Emergency?
Sudden or severe breathlessness in a dialysis patient can be an emergency.
Seek immediate medical attention if breathing difficulty is accompanied by:
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Severe shortness of breath
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Inability to lie flat because of breathlessness
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Blue or grey lips
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Chest pain or pressure
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Confusion
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Fainting
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Very low oxygen levels
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Severe swelling
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Coughing up pink or frothy sputum
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Rapid deterioration
These symptoms can occur with serious heart or lung problems, including severe fluid accumulation in the lungs.
Can Dialysis Completely Prevent Breathlessness?
Not always.
Dialysis can remove excess fluid and waste products, but it cannot eliminate every possible cause of breathlessness.
A patient may still develop:
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Heart disease
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Lung disease
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Anemia
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Infection
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Fluid overload between sessions
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Other medical conditions
Persistent symptoms therefore require medical evaluation even when the patient is receiving regular dialysis.
Why Is Dry Weight Important?
Dry weight is an estimated target weight representing the patient's weight when excess fluid has been removed and the patient is considered close to their appropriate fluid status.
If the estimated dry weight is inaccurate, the patient may remain fluid overloaded or may have excessive fluid removed during dialysis.
Signs that the dialysis team may need to reassess fluid status include:
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Repeated breathlessness
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Frequent swelling
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Recurrent low blood pressure during dialysis
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Significant cramps
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Rapid weight changes
Dry weight should be determined and adjusted by the treating dialysis team.
Breathing Problem Evaluation at Prabhakar Bhurke Clinic
At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides individualized nephrology care for patients with advanced kidney disease and dialysis-related complications.
Evaluation of breathing problems may involve:
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Assessment of fluid status
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Review of dialysis history
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Blood-pressure monitoring
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Weight and swelling assessment
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Kidney-function and electrolyte testing
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Anemia evaluation
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Medication review
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Assessment for infection
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Coordination of cardiac or respiratory evaluation when required
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Review of dialysis prescription and fluid-removal goals
The objective is to identify the underlying cause rather than simply treating breathlessness as a routine dialysis symptom.
Frequently Asked Questions
Why do dialysis patients have breathing problems?
Breathlessness can result from fluid overload, heart disease, anemia, infection, pleural effusion, low blood pressure during dialysis or other conditions.
Is shortness of breath normal during dialysis?
It should not automatically be considered normal. New or worsening breathlessness during dialysis should be reported immediately to the dialysis team.
Can fluid overload cause breathing problems in dialysis patients?
Yes. Excess fluid can accumulate in the lungs or surrounding tissues and cause significant breathlessness.
Should a dialysis patient drink water when feeling breathless?
Not without medical advice. If fluid overload is responsible, drinking additional water may worsen the problem.
Can anemia cause breathlessness in dialysis patients?
Yes. Significant anemia can reduce oxygen-carrying capacity and contribute to fatigue and shortness of breath.
When should a dialysis patient go to the hospital for breathing difficulty?
Severe or sudden breathlessness, chest pain, confusion, fainting, blue lips, very low oxygen levels or rapidly worsening symptoms require urgent medical assessment.
Conclusion
Breathing problems in dialysis patients can have many causes, and the symptom should never automatically be dismissed as a routine part of dialysis.
Fluid overload is an important possibility, particularly when breathlessness occurs with swelling, rapid weight gain or difficulty lying flat. However, heart disease, anemia, infection, pleural effusion, low blood pressure during dialysis and other conditions can also cause breathing difficulty.
The appropriate treatment depends on the underlying cause. Management may involve adjusting fluid removal during dialysis, treating anemia, addressing infection, managing heart disease or modifying other aspects of the patient's care plan.
If a dialysis patient develops new, persistent or worsening breathlessness, prompt communication with the dialysis team or nephrologist is important. Sudden severe breathing difficulty requires urgent medical attention.
For individualized dialysis and kidney-care evaluation, consult Dr. Sandip Prabhakar Bhurke at Prabhakar Bhurke Clinic.
Medical Disclaimer
This article is intended for general educational and informational purposes only and does not constitute medical advice, diagnosis or treatment. Breathing difficulty in a dialysis patient can have multiple causes, some of which may be life-threatening. Do not assume that breathlessness is caused by fluid overload or attempt to correct it by changing fluid intake or dialysis treatment without medical guidance. Do not change, skip or shorten dialysis sessions or alter prescribed medicines without consulting the treating team. Seek emergency medical attention for sudden or severe breathlessness, chest pain, confusion, fainting, blue or grey lips, very low oxygen levels, coughing up pink or frothy sputum or rapidly worsening symptoms. Consult Dr. Sandip Prabhakar Bhurke or another qualified nephrologist for individualized medical evaluation.
