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By Dr. Robert Lynn
Disclaimer: This article is for informational purposes only and is not intended to be a substitute for medical advice or diagnosis from a physician.
The kidneys are involved in so many different bodily functions that it is impossible for dialysis to replace everything a healthy kidney can do. Staying on the kidney diet (also known as a renal or dialysis diet), plus following fluid restrictions, can help, but medicines can assist people in maintaining a higher quality of health for a longer possible time. People with kidney disease who actively participate in their medical care and understand their medicines usually come out ahead when it comes to feeling their best. Here are seven prescriptions people on dialysis may need.
Nearly all patients with end stage renal disease (ESRD) who are on dialysis, have anemia. Anemia occurs when a person has a low red blood cell count. Kidneys make and secrete the hormone erythropoietin. Erythropoietin is the hormone responsible for keeping a normal red blood cell count, and the kidneys are responsible for making and secreting this hormone.
Most patients with renal failure on hemodialysis will get erythropoietin during each treatment by intravenous injection into the return dialysis tubing. Most peritoneal dialysis (PD) patients will get erythropoietin by injection directly under the skin.
Normally, red blood cells make up about 36-44 percent of the blood. Before erythropoietin was available, most dialysis patients had a red blood cell count of only 20-26 percent. Now with proper management people with CKD on dialysis have normal red blood cell counts.
In order for erythropoietin to work well, iron needs to be present to make red blood cells. Without iron fewer red blood cells are made, and are smaller in size and not able to carry as much oxygen. Small amounts of red blood cells—with iron—are lost during a hemodialysis session. If iron is not replaced, eventually dialysis patients lack enough iron and erythropoietin and do not function as well. Because of this, most dialysis patients need to receive iron.
Oral iron can be used, but frequently is not effective, because many people find it causes stomach pains and constipation. Sometimes the iron losses are too great to be replaced by oral iron.
Many dialysis units now give small amounts of intravenous iron during hemodialysis.
Regular blood tests will tell a patient's doctor if they need iron therapy.
With careful iron management and the use of erythropoietin, over 90% of patients can enjoy energy levels that come from having a normal red blood cell count.
People with chronic kidney disease (CKD) and those on dialysis can experience loss of bone minerals, including calcium and phosphorus. The calcium and phosphorus can also mix together, get hard and build up (forming calcifications) in the small blood vessels of the feet, intestines and heart. This condition can lead to amputations, abdominal pain, gangrene of the intestines and heart failure. These complications are due to the mix of dietary calcium, phosphorus, vitamin D and a hormone called PTH (parathyroid hormone).
Active vitamin D controls the balance of calcium, phosphorus and PTH. But, vitamin D that the body naturally gets from sunlight and food is inactive when renal failure occurs. The oral form of active vitamin D may be effective in preventing high PTH.
When PTH levels rise, there is inflammation in the bones, plus calcium and phosphorus are lost from the bones and move into the bloodstream. Because of kidney failure, the kidneys can no longer get rid of the extra phosphorus that's in the blood. Dialysis removes only a little bit of phosphorus. Preventing or reversing this process can be done through diet and medicines such as phosphorus binders.
Even when patients limit foods that are high in phosphorus, they would still have a high phosphorus level if they didn't take their phosphorus binders. The binders prevent the body from absorbing the phosphorus from the foods eaten.
Because most patients will require 3 to 6 pills/capsules with every meal, calcium absorption from some medicines can be significant enough to cause concern. It's always recommended to follow a doctor's prescription and ask questions if a person is concerned about his or her medicine intake.
The dialysis procedure removes large amounts of water-soluble vitamins, such as vitamin C, B-complex vitamins and folic acid. While a kidney diet can usually keep up with these losses, many people on dialysis don't always have an appetite. Most nephrologists feel that the use of a B-complex vitamin along with folic acid is a good protection for when patients don't have an appetite.
Because heart disease is common in people on dialysis patients many studies are now looking at medicines that can decrease the rate of heart disease. High homocysteine levels are commonly found in patients with heart disease and are also found in patients on dialysis. High doses of folic acid can lower homocysteine levels and high dose folic acid therapy is being evaluated as a possible preventative treatment in dialysis patients.
Many dialysis patients have itching and dry skin. While it is important to find and correct the cause, the itching can frequently be treated with topical hydrating agents or topical cortisone along with oral antihistamines.
Some people who are on dialysis are prone to leg cramps while on dialysis and at nighttime. This can be due to the rapid fluid and electrolyte shifts in and out of muscle cells from the hemodialysis treatment. Vitamin E has been said to help many people as a preventative measure for cramps when taken either before dialysis or at bedtime.
People with CKD, as well as those on dialysis, need to be involved in all areas of their care. They must be an active member of their health care team by watching their diet and making sure they understand and take the medicines they need to improve their longevity and quality of life.
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