Is dialysis painful or uncomfortable? 

Dialysis itself is generally not painful, as the filtering of blood does not cause physical sensation. However, patients may experience brief discomfort during the insertion of needles for haemodialysis or a feeling of fullness in the abdomen during peritoneal dialysis. While the treatment is life-sustaining, it can occasionally cause side effects like muscle cramps or fatigue, which your clinical team can help manage to ensure your sessions are as comfortable as possible. 

For most people, the main challenge of dialysis is not pain, but the time commitment and the physical sensation of fluid being moved within the body. In the UK, the NHS provides various ways to minimise discomfort, including the use of local anaesthetic creams for needle sites and adjusting the speed of the machines to prevent sudden changes in blood pressure. Understanding what to expect can significantly reduce anxiety for those starting treatment. 

What We Will cover in This Article 

• The sensation of needle insertion in haemodialysis and how to manage it 

• What it feels like when fluid is exchanged during peritoneal dialysis 

• Common side effects like muscle cramps, nausea, and ‘dialysis hangover’ 

• How the clinical team monitors and adjusts your treatment for comfort 

• The psychological impact of the dialysis routine and long sessions 

• Practical tips for making your dialysis sessions more comfortable 

Sensations during haemodialysis needle insertion 

The most common source of discomfort in haemodialysis is the insertion of two needles into the arteriovenous (AV) fistula or graft at the start of each session. This sensation is similar to having a blood test or a vaccination. Because these needles are used three times a week, the skin can become sensitive. To help with this, many patients use a local anaesthetic cream or spray (often called ‘numbing cream’) that is applied to the skin about an hour before the session begins. 

Once the needles are in place and secured, you should not feel any pain. The blood moving through the tubes and the machine is painless. If you do feel sharp pain or a burning sensation around the needle site during the treatment, you must alert the nursing staff immediately, as this could indicate that a needle has shifted. Most patients spend their four-hour sessions sitting in a specialised chair, reading, watching television, or sleeping. 

The feeling of peritoneal dialysis exchanges 

Peritoneal dialysis does not involve needles for the actual treatment, which many patients find more comfortable. Instead, the sensation is one of ‘fullness’ or ‘bloating’. When the cleaning fluid (dialysate) is drained into your abdominal cavity, you may feel a slight pressure, like how it feels after eating a very large meal. Some people also experience a mild tugging sensation when the fluid is being drained out. 

While this fullness can be unusual at first, most people adjust to the feeling within a few weeks. If the fluid causes actual pain, it could be a trigger for an infection check (peritonitis) or an adjustment of the fluid volume. For those using an automated machine (APD) at night, the process happens while they sleep, and many find they are not even aware of the exchanges taking place once they have settled into a routine. 

Comparing Comfort: Haemodialysis vs. Peritoneal Dialysis 

The following table differentiates between the typical sensations and discomforts associated with each method: 

Feature	Haemodialysis (Hospital)	Peritoneal Dialysis (Home)
Initial Sensation	Brief needle prick	Feeling of abdominal fullness
During Treatment	Generally no sensation	Slight pressure or bloating
Side Effects	Cramps, dizziness, fatigue	Possible backache, bloating
Comfort Level	High (nursing care provided)	High (freedom of home environment)
Pain Management	Anaesthetic creams/sprays	Volume and temperature adjustments
Mobility	Limited to a chair/bed	Can move around during CAPD

Causes of discomfort during treatment 

Discomfort during dialysis is often caused by the speed at which fluid is removed from the body. If your body has gained a lot of fluid weight between sessions, the machine must work harder to remove it. This rapid fluid shift is the primary cause of muscle cramps, particularly in the legs, and a sudden drop in blood pressure, which can make you feel dizzy or nauseated. This is why following your fluid restriction advice is one of the best ways to ensure a comfortable session. 

Another cause of discomfort is the temperature of the dialysis fluid. If the fluid is too cold, it can cause shivering; if it is too warm, it can cause sweating. Modern machines are highly adjustable, and nurses can change the temperature settings to suit your preference. Fatigue, often called the ‘dialysis washout’ or ‘hangover’, is also common after a session as the body adjusts to the rapid cleaning of the blood. 

Triggers for intervention by the clinical team 

During a dialysis session, your blood pressure and heart rate are monitored frequently. A sudden drop in blood pressure is a trigger for the nurses to slow down the pump or give you a small amount of saline fluid to help you feel better. If you start to feel ‘funny’, lightheaded, or develop a headache, these are triggers for you to speak up. Nurses can often stop a cramp before it becomes painful by adjusting the machine settings immediately. 

In peritoneal dialysis, a major trigger for concern is if the fluid coming out of your abdomen looks cloudy or if you develop sudden abdominal pain. These can be early signs of peritonitis, which is an infection. Because this requires urgent antibiotic treatment, the renal team provides 24-hour contact numbers so that any discomfort can be assessed and treated before it becomes a serious issue. 

Differentiation: Physical vs. Emotional discomfort 

It is important to differentiate between physical pain and the emotional or ‘lifestyle’ discomfort that comes with dialysis. While the physical sensations are usually manageable, the emotional toll of sitting in a clinic for 12 hours a week can be draining. This is often described by patients as a sense of ‘restlessness’. 

Clinical teams differentiate their support by offering psychological services or encouraging home-based therapies for those who find the hospital environment stressful. Improving your comfort often involves a combination of physical adjustments like using better cushions or numbing creams and finding ways to keep your mind occupied, such as using the hospital’s Wi-Fi to work or watch movies. 

My final conclusion 

While dialysis involves some initial discomfort, such as needle pricks or a feeling of fullness, the process itself is not painful. Most side effects, like cramps or dizziness, are caused by fluid shifts and can be managed effectively by your clinical team. By following your dietary and fluid advice and using available anaesthetic options, you can make your dialysis routine a manageable and relatively comfortable part of your life. 

If you experience severe, sudden, or worsening symptoms, such as extreme breathlessness, sudden chest pain, or severe confusion, call 999 immediately. 

Authority Snapshot 

This article was written by Dr. Rebecca Fernandez, a UK-trained physician with an MBBS and experience in cardiology, internal medicine, and emergency care. Dr. Fernandez has significant experience in patient assessment and managing the clinical needs of those undergoing renal replacement therapy. This guide is based on standard NHS protocols to provide accurate and safe information regarding patient comfort during dialysis.