what meds with dialysis

[texasstyle]

Hello everyone. Am I correct here in knowing that a blood thinner & a red blood cell booster such as Procit are used during every dialysis session? My husbands hemoglobins go down occasionally on his lab work. I have some understanding that the kidneys produce a hormone which helps stimulate red blood cell prodcution. I am also aware that hemoglobins are part of the make up of the red blood cell which carry oxygen through out the body. How many units of a red cell booster are given? I am assuming a blood thinner is given so there is no clotting around the fistula. I've hears the needle gage is pretty big. Any information is appreciated. Carolyn

[jbeany]

Most patients on hemo use a dose of heparin, a blood thinner, during every dialysis session, to prevent clots in the machine and the tubing carrying the blood, as well as the needles in the arm.  The dose is initially prescribed based on body weight, and then adjusted depending on how fast your blood tends to clot.  If there are visible clots in your filter after most runs, they will up the dose.  Dialysis machines are designed to gradually give heparin directly into the lines returning blood to the dialysis access.  Some patients are allergic to heparin, though.  Doing regular saline flushes of the tubing and machine is an alternative to heparin. 

Procrit (or Arenesp, a similar product), also commonly referred to as "epo"  is not given at every session.  It is an artificial version of the hormone that causes bone marrow to make red blood cells.  It's usually given on a weekly basis, through a port in the lines of the dialysis set-up.  Dosages vary depending on the patient's particular body chemistry.  (I'm on 40 units. - That's a pretty common dosage. I've been on as high as 100 and as low as 15.)   Blood work is done on a weekly basis, as needed, and epo is only given if the patient's hemoglobin falls below 12.  Medicare and most other insurances will not pay for a dose if the patient is higher than 12.

[texasstyle]

Thanks jbeany. All this is so helpful.Thinking more about home dialysis & things like this will help in the decision. On one hand I feel that there are benefits to in center such as the technician's doing all vs. having to be responsible for it at home. In center does the blood work, medications as you mentioned during treatment, and the Doctor comes through vs going to his office.I want what's best or my husband. What ever he needs I will there for him. I can see the benefits of doing it home too. Tonight we went the local minor league baseball stadium but had to leave a bit early because starts at 6 am tomorrow. His feet and legs were starting to hurt from fluid build up. I knew something about the red blood cell booster as I used Procrit while on treatment for Hep C except insurance will not pay for it until you reach 10 or below for that kind of treatment. I can tell you by the time my hemos were down to 9, I was exhausted and so short of breath. I feel for dialysis patients. Everyone in life goes through some kind of battle but this battle seems to carry on from week to week. I always keep the saying "It's not what deals you, but how you deal with it" close to heart now. Oh gosh, I just thought of something: dealing with the insurance for  home dialysis. In center takes care of most of that. I always envision a dialysis session as depressing in the way that you are surrounded with other ill patients in a hospital type setting so frequently. I have to give encouragement to all of you on dialysis. You guys are a lot stronger than you think you are.

[cookie2008]

Hi texasstyle, im on homehemo and I think it is so much better than being in center, yes you have alot of responsibilities but you are in charge which you should be. I dont deal with the insurance company my center does. I see my neph in the center once a month and thats when I also recieve my epo shot. My husband is my partner and he draws my labs and we call fedex and they come to the house. It seems like alot but each day it does gets easier.