Question about binders

[paul.karen]

My neph gave me Renvela to start taking with meals.

My question is,  i looked it up on the net and it says that no tests have been done with Renvela on patients who are not on dialysis.
Do people usualy only start taking binders once they have started dialysis.  Has anyone taken binders Pre-dialysis.

Should i wait till i am on dialysis to start taking them. One more pill to add to my collection

[RichardMEL]

Yes, I was taking binders for a little while before I started. I was originally on Alutabs and caltrate but later on moved to Renagel.

I don't think it is THAT unusual. If your phos. levels are too high it's something that should be managed even pre-dialysis. I was told it was sort of like managing the symptoms so you don't get anything else nasty happen.

[dwcrawford]

No one has given me  binderss.  My phosphous was low and protein low.  Is that the reason?  should I ask next time?

[David13]

Binders are for phosphorous control, usually taken with meals to help eliminate the phosphorous that is in most foods. 

If your phosphorous is low, you probably won't need to take binders.  They should be keeping an eye on your phosphorous levels and let you know if it goes up.

[paul.karen]

Ok   

The know tests on predialysis patients threw me a little. 

[jbeany]

I took Phoslo for almost a year before I started dialysis.  I think it just means you have a doc who actually pays attention to something besides your BUN.  Not a bad thing.

[RichardMEL]

No one has given me  binderss.  My phosphous was low and protein low.  Is that the reason?  should I ask next time?

All good Dan! As has been mentioned you only need them if your phos is at risk of getting too high. Most dialysis patients end up on binders but not all so you could be a lucky one... but hey it's just another pill to take with food..no biggie! Don't panic though. As long as they keep an eye on your labs (and you do too!) it should be fine.

[Zach]

No one has given me  binderss.  My phosphous was low and protein low.  Is that the reason?  should I ask next time?

As you begin to increase your protein intake, your phosphorus will eventually rise, leading to the need for phosphate binders.

[dwcrawford]

I'm trying so hard to eat protein... eggs are helping me get closer.  I may need to get a powder but I understand that not "bio something or other"...  Man, do I need to start reading all the material.

[Rerun]

A normal functioning kidney balances Calcium and Phosphorus.  When a kidney is not function correctly, or not at all, then your phosphorous doesn't dialyze out as well and will get higher and higher in your blood stream. So your brain says "WOW Phosphorous is very high and calcium is supposed to be equal" So it triggers your Parathyroid to release a hormone to get calcium out of your bones to equal your high Phosphorus levels.  Thus leading to bone disease to a weakened state where if not managed your bones will snap.  That is why Epoman was in a wheel chair.

Phosphorous tablets act like little sponges in your stomach to soak up phosphorus.  So, if you are having a lot of cheese or milk, or muffins take an extra Phos tablet to soak up extra Phosphorus.

                                                             

[paul.karen]

So i was told to take them when i eat three times a day.

So if i have a Muffin before bed should i eat one then as well.  Or just with the big meals.

Thanks for all the input....

[Savemeimdtba]

For the big meals - I take the reccomended dosage (which is two for me).  For snacks or small meals - I take half of that (so, one pill).  You always want to take one anytime you eat anything because there's phosphorus in EVERYTHING. 

[joyfulmother]

For the big meals - I take the reccomended dosage (which is two for me).  For snacks or small meals - I take half of that (so, one pill).  You always want to take one anytime you eat anything because there's phosphorus in EVERYTHING. 

You see this is the kind of thing that irks me (even though I really like my doctor) - I just started taking binders after being on PD for 4 months.  The doctor mentioned last appt that my phosphorus was pretty high and asked me if I had talked to the dietitian.  As he was walking out the door I asked him about binders - "You aren't on binders?" he says , looks at my chart and writes a prescription for 2 binders 3 times a day before every meal.

I wasn't given any education on it.  Like your advice, Kristi, taking a halfof that before a snack - they shouldn't assume because they do this sort of thing all day that their patients know what to do.

[dwcrawford]

Does the doctor tell you about these things or the dietician.  I was taking Calcitrol for several years and the dietician told me to stop.  Of course I'll confirm these things with the doctor, but I'm just wondering where to go for all this info.  I asked her about binders and she said I didn't need them now.  This is all soooooo confusing.  I need a keeper.

[joyfulmother]

The only thing *my* doctor told me was that the binders were high and that my dietitian could tell me where to get them cheaper online.  (As it turns out my insurance paid all but $1.10 of it).

[paul.karen]

Ah thank you kristi    This is what i needed to hear.  So eat food eat a binder period.

And becky i hear what you are saying it can be frustrating.

My doc gives me months worth of pills like binders and pills for my bones cant think of the name.  Everytime i see him i ask if he has samples.  he is good like that.

DW it by all accounts should be your doctor IMO saying when and if you need any medications.  A dietitian at least the ones i speak with just help get you a decent diet and exercise program going.

[Savemeimdtba]

My dietician is the one who told me to take the binders at snack time as well.. it did take a month of high phosphorus for us to figure out what I was missing.  Like someone said above, if they don't tell us - we don't know.. and i guess that's why this site is so important! 

[dwcrawford]

My center has a big sign in the lobby that says "don't forget your binders".

This dietician seems to be on the ball.  The doctor brought her around and said that she was the best dietician  you can get.  She did seem pretty sharp. 

[Zach]

Here's a good illustration of how phosphate binders work.
 

[jbeany]

Once you've done the renal diet for a while, you get a better idea of what has high levels of phos and what doesn't.  I vary my binder amount with the meals and snacks I eat.  I take Fosrenal, which comes in big tablets, like over-sized Tums.  If I'm having a meal with a full serving of cheese, meat, nuts or peanut butter, I take the whole tablet - 1000 mg.  If I'm having a meal with some lower phos items - say an english muffin with bread and jam, then I take half a tablet.  If my snack is plain fruit or veggies, then I skip it.

[RichardMEL]

I think it's crazy if you have multiple health professionals leaving it to each other to perscribe different medications!!! For me I verify and do absolutely everything through my neph because in my opinion he is the central core, and the most knowledgeable person about my condition and my circumstances and would be the one to keep things in the best balance (eg: calcitricol for activated vitamin D v phosphate binders v sensipar etc) because it's all a delicate balance to maintain. Thank god I haven't had to go through the dietician "review" they do (supposed to be every year but I seem to have slipped under the radar, and I'm quite happy about that  ) because frankly while they can give useful advice in terms of what is high in this or that and appropriate to have in terms of the general renal diet, I would refer any thing they suggested to my neph for approval. Of course I am in a hospital environment where my history and charts are readily available, so it's less of an issue I think, but I would worry if a neph said to me "oh the dietician will handle that" - somehow that seems a bit wrong - I understand micromanaging particular areas, but you need to review the overall picture too, IMHO.

As for snacks and the like, I only take an extra binder if I'm having something I know is heavy in phose (like a slice of pizza  ) if I'm just having a biscuit or something I won't bother.

Got my monthly labs yesterday everything A-OK 

[pdpatty]

This site is good for meal planning

http://www.nal.usda.gov/fnic/foodcomp/Data/SR17/wtrank/sr17a305.pdf

You really need this one also,what may be low in phorphorus can be dangerously high in potassium

http://www.nal.usda.gov/fnic/foodcomp/Data/SR15/wtrank/sr15a306.pdf

[TiffanyJean]

Richie takes Renvela - he just started taking them again. he takes 2 800mg with every meal and is supposed to take 1 with snacks.