Effect of medications whilst a Dialysis-patient.

[kristina]

This is a question about the medications one takes whilst being a Dialysis-patient.
I am interested in the impact these medications might have on other organs.

And, I wonder if the body could be so affected by these medications
that a kidney-transplant-operation would be out of the question?

I should clarify that this is only about any medication
one has to take whilst being a Dialysis-patient.

Thanks from Kristina.

[monrein]

Which meds in particular Kristina?  Heparin?  Iron?  Blood pressure?  I think it would depend on the person, any other underlying conditions requiring meds and on the meds themselves.  I spent 6 years total on D, took a bunch of meds for BP, also dilantin for epilepsy, continued on prednisone after first trx failed but always avoided over the counter meds that were hard on kidneys, never took NSAIDS and as little tylenol as possible.  I think that staying in good physical shape through exercise and a sensible diet are the best ways to ensure a good outcome for a transplant or any kind of surgery.

[M3Riddler]

This is a question about the medications one takes whilst being a Dialysis-patient.
I am interested in the impact these medications might have on other organs.

And, I wonder if the body could be so affected by these medications
that a kidney-transplant-operation would be out of the question?

I should clarify that this is only about any medication
one has to take whilst being a Dialysis-patient.

Thanks from Kristina.

Kristina,

Like the previous reply stated.....it depends on the medications and the dose. Medications affect people differently. Do you have a list of meds that you would like to know about?  Some meds are dialyzed out through dialysis where others are not.

///M3R

[RightSide]

This is a question about the medications one takes whilst being a Dialysis-patient.
I am interested in the impact these medications might have on other organs.

The riskiest medications are the erythropoietin analogues, like Aranesp and Epogen:  Elevated risk of stroke, especially if hemoglobin count rises to 13.  Also if you already have had cancer, those meds can make the cancer worse, or cause a recurrence.

http://www.rxlist.com/aranesp-drug.htm

[kristina]

Thank you very much for your kind replies.

I really wanted to know about the medications given to Dialysis-patients,
like Epogen and Aranesp. Thanks for mentioning the problems associated with these medications.

I have no idea of the types of medications used, so I don’t have a list of any yet.

It seems that some of these medications at least may be ok,
and not cause damage, if strict monitoring of the bloods is carried out.

I also am grateful to learn that other conditions may be affected by these medications
and may even cause a recurrence. This is all news to me
and I thank you very much for mentioning these important points.

Kind regards from Kristina.

[jbeany]

The original version of epo was called Procrit.  It has side effects the manufacturer listed as "flu like symptoms."  Like hell.  I called it "The baseball bat in the bottle."  Forget getting out of bed the next day - except to empty the puke bucket once in a while.  The muscle aches were horrible - it really did feel like I'd been beaten.
Thankfully, Aranesp didn't do that to me. 
Iron pills do horrible things to most people's digestive system.  Personally, I just threw most of them right back up. 
I slowly went off my bp meds as my weight went down and I switched to home D, which lower my blood pressure.  Those have all the same side effects for a D patient as they do for anyone else.  Dizziness is common.  I stopped driving pretty much anywhere for a while - passing out behind the wheel and going through the windshield would surely take me off the list!  Eventually, I got different meds that didn't do that to me.

Really, if it's a med - it's got side effects.  Nothing new there.  Like rightside said, Epo at high doses could cause strokes or clots - which would certainly hamper your ability to get and stay on the list.  That's why the docs walk such a fine line when they dose it. 

Anything med could cause an unusual side effect for an individual, d patient or not.  The reality is, there aren't any other good options to the meds, though.  You can refuse the epo - but then you either live with a hemoglobin so low that you are completely incapacitated or eventually dead, or you opt for transfusions that raise your antibody levels and lower your chance of a match with every new pint of blood.
It's all a balance of picking meds that work for you and hoping for the best outcome.

[kristina]

Thanks jbeany for such a comprehensive answer,
you have certainly covered lots of ground and this is very interesting information.

I asked this question because I suffer from drug-intolerance & allergies (often found in Lupus-patients)
and it is important for me to know about side-effects because, in my experience
I usually get some side-effects even with a very low dose of whatever.

You can imagine how I feel about the prospect of Dialysis,
with all the essential medication one needs to take.

I haven’t realized how powerful the medications are that you are talking about,
that are necessary for Dialysis-patients. I thought they may have been just a supplement
because the body is missing something on Dialysis.

But this sounds like really serious medication
where there is no way out except a careful balancing-act.

Thanks, I have learnt a little bit more now, it is much appreciated.

Kind regards from Kristina.

[RightSide]

Remember too that there are prescription meds, like Bactrim or Levaquin, that are designed to be cleared from the body via the kidneys.  If your kidneys have failed, then those meds may not be cleared adequately, and may build up to toxic levels.  For that reason, you must tell EVERY physician and EVERY dentist and EVERY pharmacist you meet that you have renal failure, so that they can adjust dosages accordingly.

Here are some general guidelines to adjust dosages of prescription meds for renal failure:

http://www.globalrph.com/index_renal.htm

[kristina]

Thanks RightSide for this very useful website.
I would have never thought of this myself,
so I am very thankful that you have brought it to our attention.

Thanks again from Kristina.

[jbeany]

There is a renal vitamin they give everyone as well, because of what strips out during D.   It's not any different in side effects from any other multi-vit (meaning minimal or none) - just in proportions made to deal with D patient needs. 

You also have to remember that "harmless" things often stop being harmless once your kidneys fail.  Regular vitamins are off-limits because of additives that often contain phosphorous, potassium, etc.  Those "harmless, natural" herbal supplements can be fatal.   As Rightside pointed out, meds that have no side effects for patients with good kidneys are often toxic to those with low function.

[kristina]

Thanks jbeany. Point taken.
 
I have already noticed this even though my kidneys still work 10-12% and I am not yet on Dialysis.
 
It seems one has to be extremely vigilant with everything one eats and drinks
especially over the counter products which one can buy so easily
for the many small ailments we get from time to time.

As has been mentioned already one must always consult the chemist/professional
whatever medication or supplements one takes.

The criteria for transplant seems to be so strict
that if one wishes to go down this route
one has to be extremely careful with medications & supplements
to avoid problems which might stop one from being put on a transplant-list.

Thanks again from Kristina.

[RichardMEL]

To be fair I have found that a lot of this becomes second nature after awhile and it's not something you actually have to consciously think about - like with the renal diet. I would find myself thinking about, for example, food options and automatically discarding this or that because of high potassium content, or phosphates, or deciding that yes, I can have that, but I'll need an extra binder to take with it. This sort of process would, after a time, become almost subconscious (and of course after awhile you get to know what foods and stuff are OK and what aren't, so you tend to gravitate to what you know is OK vs. what isn't).

With meds, like over the counter stuff, apart from discussing with your renal team, the other thing is to carefully read ingredients and note things like potassium, phosphates, calcium etc (for example, many vitamin C tablets contain a lot of calcium).

The complexity of the meds you wind up on when on dialysis is mostly about containing the situation and keeping a balance to help out with what your kidneys are not doing. eg: keeping the Calcium/Potassium/Phosphates/PTH all in some kind of uneasy balance, and this of course ties in with the renal diet. It's all part of supporting the body to keep things as stable as possible.

[kristina]

Thank you, Richard.

From the patient’s point of view I think you have summed it up very well indeed.
You show a good way of looking at it: diet; over-the-counter-products; and, prescribed medications.

All of these as you say are used to find some balance whether it is pre-Dialysis, Dialysis or transplant.

Thanks for the clarity.

Kind regards from Kristina.