When I start dialysis, will I still need to take pills?
What are phosphate binders, and why do I need them?
Healthy kidneys remove excess phosphorus, a mineral that is present in many foods. Dialysis is not very efficient at removing phosphorus, and too much in your system is harmful. High phosphorus stimulates overproduction of parathyroid hormone (PTH), which contributes to bone disease and can also cause itching.
Fortunately, phosphate binders can help. Binders are medications taken within a few minutes of all meals and snacks. In your gut, they bind to phosphorus in your food to reduce the amount of phosphorus absorbed into your bloodstream. Reducing phosphorus in your diet and taking phosphate binders helps calcium stay in your bones where it belongs.
Phosphate binders usually contain calcium. Calcium carbonate (Tums®, OsCal®, etc.) and calcium acetate (PhosLo®) are common phosphate binders. Newer phosphate binders without calcium are also available. Sevelamer (Renagel®) is the most commonly used non-calcium phosphate binder.
Taking your phosphate binders is one of the most important things you can do to take good care of yourself.
What vitamins should I take or avoid?
Water-soluble vitamins. Hemodialysis and peritoneal dialysis reduce water-soluble B and C vitamins. Renal diets also tend to be low in B vitamins and vitamin C. The easiest way to replace these vitamins without getting too much is by taking a special renal multivitamin once a day. Be sure to take it after hemodialysis on treatment days.
If you take over-the-counter vitamins, read the label. Over-the-counter vitamins often have 1,000% to 2,000% of the RDA of some B vitamins—and these high doses could be toxic to someone whose kidneys don't work. Look for B vitamin levels of about 100% of the U.S. recommended daily allowance (RDA). The exceptions are two B Vitamins that help red blood cell formation: folic acid and vitamin B-6. These are recommended for dialysis patients at levels several times the RDA.
Limit vitamin C to about 60 mg per day. High levels of vitamin C can cause oxalate crystals to form in people with reduced kidney function.
Fat-soluble vitamins. Avoid vitamin A supplements. Since this vitamin is fat-soluble and not water-soluble, it can build up to higher than normal levels in people on dialysis.
Vitamin E is also fat-soluble, and is not removed by dialysis. However, some nephrologists recommend 400 to 800 IU per day of natural-source vitamin E because some studies have found that it can help dialysis patients. Ask your doctor if he or she recommends vitamin E for you.
Should I take a statin drug for my heart health?
In 2003, the National Kidney Foundation put out guidelines on managing blood lipid levels in kidney disease. They recommend a target LDL cholesterol level of less than 100 mg/dL for people who have CKD or are on dialysis. If you can't reach this target cholesterol level through diet and lifestyle changes, the guidelines suggest treatment with a statin drug—as long as you do not have liver disease.
Lipitor ®, Pravachol ®, Lescol®, Mevacor®, and Zocor® are statins available in the U.S. It's recommended that your doctor prescribe a low dose and slowly increase it to find the lowest dose that keeps your cholesterol at the target level.
Muscle pain (myopathy) is a possible side effect of statin drugs. Rarely, this muscle pain can be a sign of a serious problem called rhabdomyolysis where muscle breakdown occurs and toxic waste products are produced. The chances of having myopathy are increased if you:
If you have muscle pain or tenderness, stop taking the statin drug and ask your doctor to test your blood level of creatinine phosphokinase (CK).
What medication can help control my high PTH?
Keeping PTH in the target range (not too high and not too low) helps prevent bone problems that are common in kidney disease. If your blood level of parathyroid hormone (PTH) is too high, your doctor may prescribe a form of active vitamin D to help bring your PTH level down.
Active vitamin D and related drugs are available in several forms. The most common are calcitriol (Calcijex® or Rolcaltrol® ), paricalcitol (Zemplar® ), and doxercalciferol (Hectorol® ). Your doctor may prescribe one of these drugs for you in an injectable form or as pills.
With vitamin D treatment, sometimes blood calcium levels can become too high - so your blood calcium level must be checked. If high calcium levels are a problem for you, your doctor may switch you to a different vitamin D drug that changes your phosphate binder to one that does not contain calcium or suggest other changes.
PTH, calcium, and phosphorus must all be monitored together as you and your care team work to manage your mineral balance and the health of your bones.
How can I adapt to the changes in my body on peritoneal dialysis (PD)?
Peritoneal dialysis (PD) is a lifesaving therapy you can do yourself at home. It offers many advantages such as control over your schedule and relaxed dietary and fluid limits; However, there are physical changes you should be aware of, including:
The catheter tubing can be held in place with a special “PD belt” or by other means so it doesn't look obtrusive or get in your way. The catheter should not interfere with most forms of exercise or sexual activity. You may feel self-conscience during intimacy at first; however, in time you may learn to accept it and then ignore it.
To compensate for the several hundred calories you absorb from dialysate per day, you will probably need to reduce your intake of sugars and fats. Regular exercise can also limit weight gain and help you feel good about yourself. Even if you don't gain much weight, you should expect to need clothing that is a bit bigger in the waist.
The best way to accept the drawbacks of PD is to remember the benefits of this lifesaving therapy.
Denison Dialysis Center
DaVita At Home Training Program
1220 Reba McEntire Ln
Denison, TX 75020-9057
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