Phosphorus Turn-Around Time

[Restorer]

For someone on dialysis, how long might it take to turn around your lab numbers if your phosphorus is high? Obviously it differs by person and what type/how effective their dialysis is, but it does take longer than other things. Since dialysis is so efficient at removing potassium, your potassium numbers are usually back to normal after one session of hemo, or after, what, less than a day/night of PD?

I'm thinking about the situation where your phosphorus is high, but then you start eating a little better and taking enough binders. How quickly would your phosphorus come down to an acceptable level? My PD nurse is really pushing me to get my phosphorus down, and he keeps increasing my binders. I want to get down to normal levels before my next lab draw in a week. Think I can do it?

[*kana*]

My situation changed really quick after I had my kidneys out and I was eating the same as when I had kidneys, which got me into trouble.  I am kind of embarressed to say that last month my Phos was 8.3.      I bought a renal cookbook, shopped by labels, ate more fruit, ate 4 binders a meal and I am happy to say that my most recent Phos level was 4.5.  So for me it took the next month to be under control.  Not sure if it came down in a week because I only get my labs monthly.  I did have dry itchy eyes which seemed to go away after a week on a strict diet so maybe you will be good.  My PD dietician also mentioned that some patients will be good only the week before labs.  Don't do this alot because it is only hurting yourself in the long run.     

Best of luck! 

[RichardMEL]

Just remember eating fruit can up your Potassium level as many fruits contain high levels of K. Just to make life more fun!!!

[aharris2]

Restorer, It can be done. Prior to the next draw, be VERY strict in your phosphorus intake and aggressive in your use of binders. This will keep you from adding more phosphorus into your system. Meanwhile, the dialysis treatments will work to reduce what you've already got in you.

Question to you: What binders are you using? Perhaps they are not working for you and your doctor should consider changing them. We started on Phoslo which required massive amounts to be effective. We were then switched to Renagel when calcium became contraindicated. Alone, the Renagel wasn't very effective either. Now, we are using Fosrenal in conjunction with Renagel with excellent results.

[Restorer]

Right now I'm on 4 Renvela + 1 Fosrenol (1000mg) for each meal. I'm thinking of changing up the order I take them after I read about Renagel becoming ineffective when taken with antacids, and Fosrenol acts as an antacid.

[Lillupie]

For me, it is the opposite of what your nurse said. For me, I am "bad", cheating, right after i get my labs, so the damage is done already. You, well I only cheat the first few days after i get labs done.
Hope this helps, I wish they would come up with something to drain the phos out in our dialysis
Lisa

[RightSide]

You can get your phosphorus level down to a reasonable level in a single month--but you'll have to really work at it.  It means cuttiing back drastically on foods containing phosphorus--even if you have to go vegan.  It turns out that for most vegetables, only 25% or so of their phosphorus is absorbed by the body.  So even a vegetable like broccoli, which nominally has relatively high phosphorus, isn't that big of a problem because most of it isn't absorbed.

You might also inquire as to whether the particular brand of dialyzer (artificial kidney) they're using on you does a better than average job of dialyzing out phosphorus.  The dialyzer they use on me, the Baxter Xenium 210, is claimed to do nearly as good a job dialyzing out phosphorus as it does dialyzing out urea.  Improving the dialyzer can make a big difference.

[Zach]

You might also inquire as to whether the particular brand of dialyzer (artificial kidney) they're using on you does a better than average job of dialyzing out phosphorus. 

Adding more time to your treatment will help as well.

Phosphorus is a time-dependent solute, so the longer your treatment time, the more it is removed.

[peleroja]

As you said, every person is different.  I took 2 Phoslo with each meal for nearly 5 years.  Then suddenly my phosphorus dropped to 2.2.  They took me off the binders, and I haven't been back on since.  My phosphorus stays right in the middle, and I still eat cheese and ice cream.  Here's hoping you lower those numbers!

[Restorer]

I'm on PD, so I don't have a choice of dialyzer - what I've got is what I've got . I could definitely do more manual exchanges during the day when I'm usually dry to try and pull off more phosphorus.

But the last two months my protein has been a bit low, so while going vegan could possibly lower my phosphorus, it would also lower my protein even more.

[*kana*]

Just remember eating fruit can up your Potassium level as many fruits contain high levels of K. Just to make life more fun!!!

True, thank you.  I forget that I'm not always posting in the PD area of this forum.   I am forced to drink a glass of OJ 4 times a day to keep my K up, so the extra fruit is ok for me. 

[Lillupie]

yeah on PD it is totally different.  It drastically lowers your K. Whihc is another reason why i perfer PD to hemo anytime.

 Lisa

[HAM OP]

My doctor said the dialysis treatment removes some K , but no phosphorus.  He says to take Renvela 800mg binders with everything you eat.  The amount he says to take is the minimum.  I take 7 to 8 with a big meal of high phosphorus food.  I am on Hemo now , I do not know about PD.

[Lillupie]

7 or 8 binders per meal. Holy crap that is a lot. My dietiction (sp?) says you cant take more then 4 or 5 because then it doesnt do any good. THat is what she claims. I do know of a guy on Facebook that has to take 10 per meal

Lisa

My doctor said the dialysis treatment removes some K , but no phosphorus.  He says to take Renvela 800mg binders with everything you eat.  The amount he says to take is the minimum.  I take 7 to 8 with a big meal of high phosphorus food.  I am on Hemo now , I do not know about PD.

[Zach]

My doctor said the dialysis treatment removes some K , but no phosphorus...

Actually, with regard to phosphorus, that's not correct.

Phosphorus removal is time-dependent.
So the longer you're hemodialysis treatment time, the more phosphorus is removed.

That's why folks on nightly nocturnal hemodialysis are generally off phosphate binders and in fact, sometimes need to add phosphorus to their diet.

 

[*kana*]

Ok, we want to know......did you get your Phos level down low in a week?

[Bub]

One of the results of high phophorus I am dealing with is itching.  Once I get myy phos levels down to normal or low ranges, how long before the itching subsides.  I am miserable.

[Lillupie]

Is this the nocturnal home hemo or the in-center nocturnal hemo?

Lisa

My doctor said the dialysis treatment removes some K , but no phosphorus...

Actually, with regard to phosphorus, that's not correct.

Phosphorus removal is time-dependent.
So the longer you're hemodialysis treatment time, the more phosphorus is removed.

That's why folks on nightly nocturnal hemodialysis are generally off phosphate binders and in fact, sometimes need to add phosphorus to their diet.

 

[Zach]

Is this the nocturnal home hemo or the in-center nocturnal hemo?

Nightly Nocturnal Hemodialysis at home.

 

[dwcrawford]

I really hate to bring this up in here but.... I can't seem to get phosphrous levels up (try as I may).  Always down but yesterday's labs down more... Suggestions?

[Hanify]

Drink coke?

[del]

Eat more high phos foods!!!  Bring on the cheese, bakery stuff, beans, peas, etc!!!  A lot of people probably wish they had your problem dw!!!

[RichardMEL]

double cheeseburgers washed down with coke n ice cream should do it nicely Dan!

Wish I had your problem!

[dwcrawford]

Oh well, Richard, I'd like to be 39 too.  What'll we do?

[HAM OP]

Itching is a sign of high phosphors level.  You want to reduce your level quickly.  The effect of high levels is irreversible.  The damage is calcium deposits in your extremities which leads to amputation.  Use binders to drop levels.  Dialysis does not drop phosphorus levels.  I use RENVELA  which works real well.  I dropped my level from 9.0 to 4.0 in one month.  Ask your doctor about renvela,  it is expensive but should be covered by you insurance.