Why dialysis and infusion patients feel cold, and how clinics keep them comfortable
Feeling cold during dialysis is common and usually has several overlapping causes: some of your blood is circulating outside your body, the dialysate may be set slightly cool to help keep blood pressure stable, anemia reduces heat production, your access arm stays uncovered, and you sit still for hours. Infusion patients face similar factors. Layers, blankets and a word with your care team usually help.
Why am I so cold during dialysis?
Hemodialysis moves blood out of the body, through a filter and back again. An ESRD Network patient flyer from IPRO notes that about two cups (one pint) of blood is outside the body at any given time. Blood in the tubing and filter sits closer to room temperature than to body temperature, and the dialysate it passes against also influences how warm it is when it returns.
Several other factors stack on top of that. The access site has to stay visible, so one arm is often uncovered for the whole session. Many people with kidney disease have anemia, meaning fewer red blood cells, and the same flyer explains that people with anemia may feel colder than average. Sitting still for hours also means your muscles generate much less heat than they would if you were moving around.
What temperature is dialysate, and why do clinics use cool dialysate?
Dialysate is the cleansing fluid on the other side of the filter membrane. A 2025 narrative review in International Urology and Nephrology describes 37°C as the standard machine set point, with cool dialysis usually defined as at least 1°C lower, typically 35 to 36°C, or set about 0.5 to 0.9°C below the patient's own core temperature.
The reason is blood pressure. The same review notes that core body temperature tends to rise 0.5 to 0.7°C during standard dialysis, which encourages blood vessels to widen and can contribute to drops in blood pressure during treatment. Cooler dialysate limits that vessel widening. The tradeoff is comfort: the review reports that patients in the MyTEMP trial who received individualized cooler dialysate more often reported thermal discomfort.
Dialysate temperature is a clinical decision that balances blood pressure stability against comfort. If you feel very cold, tell your nurse or nephrologist, but do not ask for the setting to be changed as a matter of preference alone; the team will weigh your blood pressure history.
Why do I feel cold during a chemo or IV infusion?
Infusion rooms share many of dialysis's conditions: long periods sitting still, an arm or chest port uncovered for the line, and air conditioning set for staff who are moving around. Fluids are often given at room temperature, which is well below body temperature, so a large volume running into a vein can leave you feeling chilled, especially in the infused arm.
Some drugs add their own effects. MD Anderson describes oxaliplatin as a chemotherapy drug known for causing cold sensitivity, sometimes painful, triggered by cold drinks or chilly air. Its tips include asking for room temperature water, skipping ice and moving away from drafts or air vents.
When is feeling cold a warning sign?
Ordinary chilliness is different from shaking chills or fever. The American Cancer Society lists fever or chills among the possible signs of an infusion reaction and advises telling your nurse immediately if you feel anything unusual. The National Kidney Foundation lists fever and chills among the symptoms of a catheter-related bloodstream infection in people on dialysis.
If you suddenly start shivering hard, feel feverish, or notice redness, drainage or pain at your access site, tell the staff right away rather than reaching for another blanket. Talk to a clinician about any new or persistent symptoms, including feeling cold all the time between sessions.
How do dialysis and infusion clinics keep patients warm?
Most units rely on simple measures: warmed or extra blankets, seating away from vents where possible, and encouraging patients to bring their own layers. Some infusion centers keep blankets in a warming cabinet.
For larger fluid volumes, fluid warming devices exist. In surgery, the UK's NICE guideline recommends that intravenous fluids of 500 ml or more and blood products be warmed to 37°C with a fluid warming device. Outpatient infusion units decide case by case whether a warmer is indicated for a particular drug or volume, so ask your team rather than assuming one can be used.
What should I wear to dialysis or an infusion?
The goal is warmth everywhere except the spot the team needs to reach. Loose layers make that easy.
A loose sweatshirt, cardigan or zip-front vest you can add or remove without disturbing your line.
Sleeves that roll or unzip well above the access arm, or clothing designed for fistula, graft or port access.
A hat, warm socks and a blanket or throw over your legs and torso.
Gloves and a scarf if they do not interfere with your access, as the IPRO flyer suggests.
For oxaliplatin, room temperature or warm drinks instead of iced ones.
Are heating pads or hand warmers safe during treatment?
Ask first. Never cover, wrap or apply heat to your fistula, graft, catheter or IV site unless the team says it is fine, because they need to see it and heat can mask problems or affect the site. Some chemotherapy drugs and conditions common in kidney disease, such as diabetes, can reduce skin sensation, and heat applied to numb skin can burn without warning.
If your team approves a warmer, keep it away from the access site, never place it directly on skin, and check the skin afterward. Keeping your core warm with layers is usually the simpler and safer option.
Key takeaways
Blood outside the body, cooler dialysate, anemia, an uncovered access arm and sitting still all make dialysis patients feel cold.
Standard dialysate is about 37°C; cooler settings are used to help stabilize blood pressure, at some cost to comfort.
Room temperature IV fluids and drugs such as oxaliplatin can make infusion patients feel cold.
Dress in loose layers that leave the access site reachable, and never heat or cover the site without asking.
Shaking chills or fever during treatment can signal a reaction or infection; tell your nurse right away.
Frequently asked questions
Can I ask for the dialysate to be warmer?
You can raise it with your nurse or nephrologist, especially if the cold is making treatment hard to tolerate. The setting is chosen partly to support your blood pressure, so the team will decide whether a change is safe for you. Do not adjust anything yourself.
Is it normal to feel cold after dialysis?
Many people feel cold during treatment, and the chill can linger for a while afterward. If feeling cold persists between sessions, ask your care team to check for contributing causes such as anemia.
Can I use a heated blanket during dialysis?
Ask your unit first. Many allow personal blankets, but heated products need approval, must stay away from the access site, and should not be used on skin with reduced sensation.
Why does my arm feel cold during an IV infusion?
Fluid running at room temperature cools the vein and the tissue around it, and the arm is usually uncovered. A blanket over the rest of the arm and body often helps; tell the nurse if the cold comes with pain, swelling or burning.
What should I bring to an infusion appointment to stay warm?
Bring a loose layer that opens around your port or IV arm, warm socks, a hat and a blanket. If you receive oxaliplatin, bring a warm drink or ask for room temperature water.
When should chills during treatment worry me?
Shaking chills, fever, or new redness or pain at your access site are not normal cold. Tell your nurse immediately, and call your care team if these start after you get home.
Related reading
Sources
Why Do I Feel Cold During Dialysis? (patient flyer), IPRO End-Stage Renal Disease Network Program
Does low-temperature dialysis still represent an advantage?: a narrative review from the last decade, International Urology and Nephrology (via PubMed Central)
Hypothermia: prevention and management in adults having surgery (CG65), Recommendations, National Institute for Health and Care Excellence (NICE)
Infusion or Immune Reactions, American Cancer Society
Catheter-Related Bloodstream Infection (CRBSI), National Kidney Foundation
How to cope with cold sensitivity due to chemotherapy, The University of Texas MD Anderson Cancer Center
About HEATJAC. HEATJAC is a thermal architecture company founded by an anesthesiologist. We design patented garment systems that capture, conduct and broaden warmth across the body, and we publish this knowledge hub because the science of staying warm should be public. HEATJAC products are not medical devices and are not intended to diagnose, treat, cure or prevent any disease.