The primary advantage of hemodialysis is the extension of life. People whose kidneys no longer work can die within weeks without dialysis or transplant.

Risks of hemodialysis include:

• Infection. The U.S. Centers for Disease Control and Prevention (CDC) notes that bacterial infections, particularly at the vascular access (site from which blood is drawn), cause considerable disease and mortality in hemodialysis patients. Catheters have greater risk of infection than arteriovenous fistulas and grafts, but use of catheters has increased.
  
  
• Clotting (thrombosis). The blood can thicken, solidify and block the vascular access. Clotting can be caused by a number of factors, including poor blood flow, compression of the site, drop in blood pressure and a technical problem with the site. Prevention and treatments include attending all hemodialysis sessions, having the blood flow through the vascular access routinely checked, avoiding compression of the access, restricting fluids and weight gain, and if necessary having angioplasty or surgical repair, according to the American Association of Kidney Patients.
  
  
• Low blood pressure (hypotension). Removal of too much fluid during hemodialysis can cause below-normal blood pressure, especially right after the procedure. The patient can ease hypotension by lying down or drinking liquids.
  
  
• Hemolysis (destruction of red blood cells). This rare but potentially dangerous side effect can result if chemicals such as chlorine and chloramine have not been removed from water used in dialysis machines, or if the tubing used is too narrow. Symptoms of hemolysis can include chest pain, abdominal pain, shortness of breath, nausea and vomiting.

Some problems common among people on hemodialysis are associated at least in part with chronic kidney failure itself. These conditions include high blood pressure (hypertension), itching, sleep disorders, abnormal heart rhythms (arrhythmias), anemia, amyloidosis (accumulation of proteins in joints and tissues) and renal osteodystrophy (weakened bones).

Anemia is common in dialysis patients, but some research has found many patients are being overtreated with anemia drugs. In 2007 the U.S. Food and Drug Administration tightened warning labels on these erythropoiesis-stimulating agents (ESAs) because of potential risks including heart attack and stroke. The agency recommends using the lowest dosage needed to avoid blood transfusions.