What drugs will I be taking on dialysis?

Avitum

Now that I have started dialysis do I still need to take my medication?

Dialysis can replace some of the functions that your kidneys used to do, but there will still be a need for you to take the tablets you are prescribed by your doctor. Some of the tablets you were taking before you started dialysis may be reduced in dose or stopped, but you may need to take some new medicines as you get established on dialysis. This booklet will tell you about some of the common drugs that many dialysis patients take, but we will not be able to cover all potential medicines here. It is still important that you ask the doctor or nurse the best time and way to take the medicines you are prescribed. Remember if at anytime you think that the tablets are making you unwell, make sure you tell the nurse or doctor.

Blood pressure medication

Unfortunately high blood pressure is common in patients who are on dialysis. This means that you may be one or more different types of blood pressure tablets. Some patients experience low blood pressure during dialysis which can be caused by taking their blood pressure tablets before they come in for dialysis. This does not affect every patient, but it is important that you discuss this with your nurse or doctor who will give you advice on which tablets you can take before dialysis. But make sure you always take your blood pressure tablets at all other times. High blood pressure can have lead to heart disease.

EPO and Anaemia

Nearly all dialysis patients suffer from anaemia because the kidney is unable to produce the hormone EPO. This hormone acts on the bone marrow to make red blood cells and keep the haemoglobin level within a normal range. However, since the 1980s we have been able to give EPO injections that have reversed the symptoms that many patients complain of with anaemia. Anaemia causes the following symptoms: fatigue or tiredness lack of energy difficulty in concentrating unable to exercise

There are many different manufacturers of EPO, but they all work the same way. You may be given the drug through an injection under the skin or intravenously during dialysis. Many patients give their own EPO at home. The dose will change depending on how well your haemoglobin is.

This is checked every month and the EPO dose changed depending upon the result.

Iron

As well as needing EPO to make red blood cells, you also need a good supply of iron to supply the red blood cells with haemoglobin. Diet is a good supply of iron, but when you are on dialysis this is often not enough, as you loose red blood cells through the dialysis process itself. Iron tablets can be used, but these often given people stomach pains and constipation. Because of this many people receive intravenous iron during dialysis. The amount of iron you are given will depend on your haemoglobin levels. These are checked on a regular basis. The iron is given during dialysis by a slow infusion and so you will not need to have any injections.

Phosphate binders
When the kidneys are working normally they help to keep the levels of phosphate in your body at a safe level. However, now that your kidneys are not working as well as they could it is important that we control your phosphate levels in other ways. Phosphate is present in almost all foods, but is higher in some than others. Your dietician will have gone through these foods with you, and we will cover these again in another booklet. The dietician will explain to you the foods you need to be careful of, but also you will be prescribed phosphate binders.
Dialysis only removes some of the extra phosphate in your body. Too much phosphate can combine with calcium and leads to hardening of your blood vessels. There are different kinds of phosphate binders, but the most common are calcium-containing binders. Whichever type of binder you are taking it is important to take these with every meal, so that they can bind the phosphate in the food you are eating and prevent your body from absorbing it.

Active vitamin D
Renal failure can lead to bone disease where you can loose calcium from the bone, leading to softening of the bones. Part of the prevention is by controlling phosphate levels, but it is also important that active vitamin D is present to control a hormone called parathyroid hormone (PTH).
High levels of PTH can lead to inflammation of the bones and muscles, loss of bone calcium, and can cause itching in some people.

You may need to take an oral form of vitamin D to help prevent or control these risks. Though not all patients will be prescribed vitamin D, many patients do need to take the tablets.

Vitamins and other supplements

When you are on dialysis there may be times when you do not have a good appetite, and so may not eat as well as you would like. Unfortunately vitamins can also be lost through the dialysis. These two facts can mean that you may need to have some vitamin or other supplements.
Many doctors will prescribe vitamin B complex, vitamin C and folic acid to help maintain your vitamin requirements.

The dietician may also prescribe special high energy drink supplements for you if your appetite is very poor.

Over the counter medicines

There is an increasing number of medicines that are available without prescription which can be bought from your pharmacy, supermarket or even local garage. You must take care before you buy or take any drugs that have not been prescribed by your doctor. Some of these drugs are unsuitable for patients with kidney disease because they may interfere with medicines which have been prescribed by your doctor. Some medicines can affect the absorption or other medicines. Some medicines have further damage your kidney. Some medicines can react with others to give you a drug reaction. It is therefore very important that you get advice from your doctor or pharmacists before taking anything that is not prescribed for you.

Heparin
During dialysis you will be given a drug called heparin. This is given by injection directly into the dialysis lines to prevent your blood from clotting while it is travelling through the blood lines and dialyzer. There are two different types of the drug either heparin or lowmolecular weight heparin. They both do the same thing, that is preventing clotting but in slightly different ways.
Heparin is given in slow infusion throughout the dialysis treatment by the dialysis machine. But low-molecular heparin is given as a single dose at the start of dialysis. The dose of the drug is individual for each patient, and may change if you experience bruising after dialysis or the dialyzer start to clot off.

So what next?

Now you have read through this a nurse or doctor will come back to answer any other questions you might have. Remember, you can ask questions at any time.

There will be other booklets for you to read later that will include the following topics:
Hemodialysis a brief introduction How does hemodialysis work? Looking after your vascular access Managing your fluid intake The dialysis diet Common drugs used on dialysis Increasing your independence Transplantation

We hope that this will help you to adapt to dialysis, helping you to feel better. Remember, you can ask questions about your treatment at any time.

B. Braun Avitum AG | Schwarzenberger Weg 73-79 | 34212 Melsungen | Germany Phone +49 5661 71-2624 | Fax +49 5661 75-2624 | dialysis@bbraun.com | www.bbraun-dialysis.com