Anemia occurs when a person has a low red blood cell count. Anemia causes fatigue or tiredness, lack of energy for exercise, difficulty in concentrating and strain on the heart.
Most people with chronic kidney disease (CKD), who are on dialysis have anemia, since the kidneys make and secrete the hormone erythropoietin. This hormone is responsible for keeping a normal red blood cell count. Now with proper management patients with chronic kidney disease on dialysis have normal red blood cell counts. The erythropoietin hormone given to patients goes under the names of: Micera®,Recormon®, ARANESP® or epoietin alpha.
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 their iron are lost during a hemodialysis session. If the 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.
People with chronic kidney disease and those on dialysis can experience loss of bone minerals, including calcium and phosphorus. The cause of bone disease and calcifications come about due to the mix of dietary calcium, phosphorus, vitamin D and a hormone called PTH (parathyroid hormone). PTH is secreted by four small glands located on the surface of the thyroid gland in the neck.
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. Calcium-containing binders are effective in preventing phosphorus absorption by combining with the phosphorus in the intestinal tract. Two other medicines, Renagel® (sevelamer) and Renvela (sevelamer carbonate) have been used as a phosphate binders. These medicines mix with phosphorus in the intestinal tract, but do not contain calcium.
Although limiting foods with phosphorus from the diet is very important, active vitamin D is necessary in maintaining normal PTH levels and in bone health. High PTH levels cause inflammation of bones, muscles and tendons, loss of bone calcium and phosphorus and may be the reason for severe itching in some dialysis patients.
The dialysis procedure removes large amounts of water-soluble vitamins, such as vitamin C, B-complex vitamins and folic acid. While a good diet can usually keep up with these losses, many dialysis patients don’t always have an appetite. Some vitamins include Nephro-Vite®, Nephrocaps® and Nephroplex®. These are commonly used, since they have been designed to replace losses specific to dialysis therapy.
There are many other medications in use, which are not for dialysis itself but are related to the most common causes of kidney disease. Patients with diabetes mellitus represent 40% of patients on dialysis. Their diabetes needs to be carefully controlled, not only with diet, but with either pills or insulin shots designed to maintain
normal blood glucose. Patients with high blood pressure (hypertension) need to be treated by establishing at an appropriate dry weight, following a low sodium diet, limiting the amount of fluid consumed and the use of high blood pressure medicines.
Once diagnosed with kidney failure a patient must consult a dietician to be given a proper diet to follow.
Dr. S. Lerutla Medical
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