How to Stay Warm During Dialysis: Practical Tips

Feeling cold during dialysis is one of the most common complaints among people on hemodialysis, and it has real physiological explanations rooted in anemia, fluid shifts, and the mechanics of the treatment itself. The good news is that a combination of simple strategies and conversations with your care team can make sessions noticeably more comfortable. Some solutions are as easy as what you wear; others involve clinical adjustments that require understanding a genuine trade-off between warmth and cardiovascular safety.

Why Dialysis Makes You Feel Cold

Several factors converge to leave you chilled during a session. One of the biggest is anemia. Kidney disease commonly leads to low hemoglobin, and with fewer red blood cells carrying oxygen to your tissues, your body struggles to maintain normal heat. A persistent sensation of feeling cold is a well-recognized symptom of the anemia that accompanies chronic kidney disease, alongside fatigue, muscle weakness, and breathlessness.¹

There is also something happening at a deeper physiological level. Research dating back decades found that dialysis patients with residual kidney function tended to have slightly below-normal body temperatures before treatment, with temperatures rising by about 0.4°C during the session itself. The hypothesis is that healthy kidneys excrete a natural cooling substance, and when kidney function is impaired, the balance shifts in ways that affect thermoregulation.² In practical terms, this means your baseline temperature may already be a bit low when you sit down for treatment.

On top of that, hemodialysis involves circulating your blood through an external machine. As blood passes through tubing and the dialyzer, it can lose heat to the environment, especially in the first hour. The combination of low hemoglobin, altered thermoregulation, and heat loss through the circuit explains why so many people shiver during sessions, even in rooms that feel comfortable to the staff walking around.

The Dialysate Temperature Trade-Off

You might assume the solution is straightforward: warm up the dialysate fluid and the patient warms up too. But the clinical picture is more complicated, because cooler dialysate has measurable cardiovascular benefits. A systematic review and meta-analysis found that lowering dialysate temperature reduced the rate of dangerous blood-pressure drops during treatment by about 70% and raised mean arterial pressure by roughly 12 mmHg compared to standard-temperature dialysis.³ Blood-pressure crashes during dialysis are a serious problem that can cause dizziness, nausea, and in severe cases cardiac events, so this is not a trivial benefit.

That said, a large randomized trial published in The Lancet tested personalized cooler dialysate against standard temperatures across thousands of sessions and found only a small, non-significant difference in blood pressure drop between the two groups.⁴ The picture, in other words, is not perfectly settled. Some trials show clear hemodynamic advantages from cooler dialysate, while the largest trial to date found the benefit smaller than expected.

What does this mean for you as a patient? It means the dialysate temperature is not something you should try to change on your own by asking your nurse to simply “turn it up.” If you are on a cooler protocol, your nephrologist chose it for cardiovascular reasons. But you absolutely can ask whether there is room to adjust it slightly. One study testing dialysate at 35°C versus 36.5°C found that blood-pressure drops occurred more than twice as often at the warmer temperature, though the difference did not reach statistical significance in that particular trial.⁵ Even a modest adjustment upward, say from 35°C to 35.5°C, might make a difference in comfort while preserving most of the protective effect. That conversation is worth having with your care team.

Interestingly, when patients on cooler dialysate were surveyed, about 80% said they actually felt more energetic afterward and wanted to continue with the cooler setting, despite the initial chill.⁶ Thermal comfort during the session and how you feel after the session are sometimes in tension. Many people find that tolerating a cooler dialysate pays off in less post-treatment fatigue and more energy for the rest of the day.

Warming Gowns and Blankets

If your dialysate temperature is set for cardiovascular protection, the most direct way to fight the resulting chill is external warming. A quasi-experimental study tested a purpose-built warming gown on hemodialysis patients and found striking results: shivering scores dropped from an average of 2.63 down to 0.37 on a standardized scale, and body temperature rose from about 36.4°C to 36.8°C. The control group, which did not wear the gown, showed no significant improvement.⁷ That study reinforces what many patients discover through trial and error: wrapping your core in something warm is the single most effective thing you can control during a session.

Not every dialysis center provides heated blankets or warming garments, so bringing your own is a smart default. A thick fleece blanket, a microwaveable heat pack, or even a heated throw (if your center allows it and has an outlet near your chair) can make a meaningful difference. Some patients layer a blanket over their torso and a second one over their legs. Hand warmers tucked into pockets or resting on your lap are another low-tech option that targets cold extremities without interfering with the treatment.

Shivering itself is more than just uncomfortable. Research has noted that shivering during hemodialysis can reduce treatment comfort, impair the efficiency of the session, and raise the risk of complications.⁷ Preventing shivering is not just about comfort; it can help ensure your treatment runs smoothly and to completion.

What to Wear to Your Session

People on dialysis often find themselves wearing a kind of unofficial uniform: loose, comfortable clothing that gives easy access to fistulas, grafts, or catheters, accommodates a blood-pressure cuff, hides potential blood staining, and allows for the weight fluctuations that come with fluid changes between sessions.⁸ These practical needs often push people toward thin, baggy T-shirts and sweatpants, which are not exactly built for warmth.

You can work within those constraints and still stay warmer. A few strategies that experienced dialysis patients swear by:

• Layer up top: Wear a short-sleeved shirt for access to your fistula arm, then drape a zip-up hoodie or cardigan over your shoulders with the sleeves hanging free. This keeps your core warm without getting in the way of the access site.
• Warm socks or slippers: Feet get cold fast when you are sitting still for hours. Thick wool socks or fleece-lined slippers are small investments that pay off every session.
• A scarf or neck gaiter: Covering your neck traps a surprising amount of body heat. It is easy to put on and remove without disturbing anything.
• Dark-colored layers: If you are worried about the occasional blood stain, dark fabrics hide marks better and let you choose warmer materials without anxiety.

Some companies now make clothing specifically designed for dialysis access, with zippers or snaps over the fistula arm so you can keep a long sleeve on your other arm. These are worth exploring if you consistently feel cold and find that standard layering interferes with your treatment setup.

Gentle Movement During Treatment

Moving your body generates heat, and light exercise during dialysis has been studied for other health benefits too. A randomized controlled trial tested pedaling exercise on a stationary bike during dialysis sessions and found it was safe and feasible, with no significant differences in treatment adequacy between the exercise and control groups.⁹ That finding matters because it means gentle pedaling did not disrupt the dialysis itself. The warmth benefit is a practical side effect: even low-intensity leg movement gets blood circulating to your extremities and raises your body temperature.

If your center has bedside pedal exercisers, ask if you can use one. If not, even simple movements like ankle circles, calf raises while seated, or repeatedly squeezing a soft ball in your free hand can help. The goal is not a workout; it is just enough muscle activation to nudge your circulation and keep your hands and feet from going numb. Check with your nurse before starting, since some patients with unstable blood pressure or certain access sites may need to modify or skip exercise.

When Cold Extremities Signal Something More

Some dialysis patients experience cold hands and feet that go beyond ordinary chilliness. Peripheral arterial disease is a common complication of long-term hemodialysis, especially among patients who also have diabetes.¹⁰ Narrowed arteries in the legs and feet reduce blood flow, making those areas persistently cold, sometimes with discoloration or slow-healing wounds.

If your feet are always icy cold, painful, or have a bluish or pale tinge even between dialysis sessions, bring it up with your nephrologist or primary care doctor. Cold extremities from PAD need their own treatment, and no amount of blankets or socks during dialysis will address the underlying circulation problem. Early detection and management of vascular disease can prevent more serious complications down the road.

The Emotional Weight of Feeling Cold

Feeling cold during dialysis is not just a physical annoyance. Qualitative research exploring how patients experience this symptom found that people described it in strongly negative terms, and it affected their psychological, physical, and social well-being. “Feeling cold” emerged as a meaningful and distressing experience among people with kidney failure.¹¹

This makes sense when you think about the context. You are hooked to a machine for several hours, multiple times a week, often in a clinical environment you did not choose. Shivering through the session adds an extra layer of misery that can make you dread coming back. Some patients in research interviews described the cold as making them feel more vulnerable and less in control. Others said it interfered with their ability to nap, read, or otherwise pass the time, which made sessions feel longer.

Acknowledging this emotional dimension matters because it can influence whether patients stick with their treatment schedule. If every session is associated with physical discomfort and distress, skipping or shortening sessions becomes more tempting. Talking openly with your care team about how the cold affects you is not complaining; it is advocating for conditions that help you complete your treatment consistently.

Peritoneal Dialysis and Temperature

Most of the advice above applies to in-center hemodialysis, but people on peritoneal dialysis face a slightly different situation. Since PD happens at home, you have far more control over your environment: room temperature, blankets, clothing, warm drinks. The treatment itself involves filling your abdomen with dialysate fluid, which some patients warm before instilling.

A randomized trial tested whether warming peritoneal dialysate to 37°C improved clearance compared to room-temperature fluid. It found no significant difference in creatinine or urea clearance, and no significant differences in abdominal discomfort, blood pressure, or body temperature between groups.¹² The researchers concluded that using dialysate at different temperatures was feasible without side effects, but that warming it to body temperature did not improve treatment effectiveness. If warming your PD fluid to a comfortable temperature makes you feel better, the evidence suggests it is safe to do so. Just do not expect it to change how well the dialysis works.

The bigger advantage of PD when it comes to warmth is environmental control. You can run your exchanges on your couch under a blanket, wear whatever you want, keep your thermostat at a comfortable level, and sip hot tea throughout. People on PD who still experience persistent cold should look to the same underlying causes as hemodialysis patients: anemia management, thyroid function, and vascular health all deserve attention regardless of which modality you are on.

Asking Your Care Team the Right Questions

Many patients feel hesitant to raise what they see as a minor complaint, especially when the clinical team is focused on lab values and fluid removal targets. But the evidence consistently shows that thermal discomfort during dialysis affects quality of life and treatment adherence, so your team should take it seriously. A few specific questions worth asking:

• What is my dialysate temperature? Knowing the number gives you a starting point. If you are at 35°C, there may be room to go to 35.5°C. If you are already at 36.5°C or higher, the focus shifts to external warming.
• Is my anemia well-controlled? If your hemoglobin is on the low side, optimizing it with erythropoiesis-stimulating agents or iron supplementation may improve your cold tolerance over time.
• Can I use a warming blanket here? Some centers have heated blankets or warming cabinets. Others allow you to bring your own electric blanket. You will not know unless you ask.
• Should I get screened for PAD? If your feet are always cold and you have diabetes or a long dialysis history, a simple ankle-brachial index test can check for arterial narrowing.

You do not need to accept chronic shivering as just part of dialysis. Between managing your anemia, fine-tuning dialysate temperature, layering up, and staying gently active during sessions, most patients can find a combination that keeps them significantly warmer. The strategies that work best tend to be the ones that address multiple factors at once: a warming gown handles heat loss from the circuit, proper anemia management improves baseline circulation, and gentle movement keeps blood flowing to extremities. Start with what you can control today and build the conversation with your care team from there.