Medicines Commonly Prescribed When on Dialysis

Erythropoiesis stimulating hormone (ESA) is usually given while on dialysis to stimulate EPO. Erythropoietin (EPO) is a hormone that is made by the kidneys. It triggers the creation of red blood cells. If the kidney is not working well, there is not enough EPO secreted and your child can become anemic, or low on red blood cells.

Your child’s hemoglobin (Hgb) is a protein that carries oxygen to the red blood cells. It is watched regularly to find out the right dose of ESA for them. The target Hgb is 10. If the Hgb rises too quickly or too high, it can cause your child’s blood pressure to rise. This may cause your child to clot their fistula or graft.

Iron is needed to make red blood cells. It helps the cell hold onto oxygen when it travels through the body from the lungs.

Your child may be on iron tablets by mouth if on peritoneal dialysis. Your child may also get the iron IV through their catheter or fistula while on hemodialysis. Iron, given through the IV, may cause your child to feel itchy, anxious and flushed. Let your child’s nurse know if they have any changes in how they are feeling when given the iron on dialysis.

If your child is taking iron tablets, they may notice these side effects:

• Darker color stools
• More constipation (difficulty having a bowel movement)
• Nausea (if taken on an empty stomach)
• It is helpful to take stool softeners for constipation if recommended by your doctor. Take iron tablets with food and avoid high calcium food or calcium supplements when taking iron by mouth.

Phosphorous binders like Renvela, sevelamer, and calcium carbonate (TUMS) can lower the amount of phosphorus in the blood. They bind with the phosphorus in food so it is not absorbed. Phosphorus rises in kidney failure because the kidneys can no longer remove it. When the phosphorus becomes too high, the calcium will become low. Low calcium will cause more parathyroid hormone (PTH) to be secreted. The PTH breaks down the bone to get calcium, causing brittle bones. Too much phosphorus also causes more itching.

Zemplar (paracalcitriol) and Calcitriol are 2 forms of vitamin D. Vitamin D plays many important roles in the body. It is very important for bone health because it helps the body absorb calcium. Vitamin D also lowers the amount of parathyroid hormone (PTH) made by the parathyroid gland. Too much PTH is released by the gland when phosphorus levels are too high. This can cause brittle bones.

There are different forms of vitamin D. Rocaltrol is an oral form (taken by mouth). Calcijex and Zemplar are given IV during dialysis. Your child may need to take both vitamin D tablets or liquid and have it IV during dialysis if their vitamin D level is low.

Several different types of medicines are used to help control blood pressure. You may find that as extra fluid is removed with dialysis your child will not need as much blood pressure medicine. Extra fluid is often the cause of high blood pressure. Impaired kidneys may also release a hormone that causes the blood pressure to be too high.

Your child’s blood pressure may become too low if they have taken their medicine before dialysis treatment, since fluid will be removed. Your child’s doctor and dialysis nurse will help you schedule the blood pressure medicine around the dialysis treatment.