Lifestyle Changes of a Dialysis Patient

When I start dialysis, will I still need to take pills?

There are a number of pills you need to take when you have chronic kidney disease (CKD), and you will still need most of them on dialysis. While dialysis cleans your blood and removes extra fluid, the kidneys have other functions that cannot be replaced by dialysis, so there are common drugs that many dialysis patients will be prescribed. Your blood pressure pills may change, and you may be able to get some of your medicines through the dialysis tubing instead of taking pills. Your physician will prescribe the medicines you need and make any changes required. Please discuss your medications with your physician if you have questions.

Can dialysis cause hair loss?

People who start dialysis do sometimes notice hair loss and changes to their skin, such as dryness and itching. Usually, hair loss is temporary, and it will begin to grow again in a few months. A hair stylist may be able to make some suggestions about how to look good in the meantime. You can download a PDF fact sheet on skin and hair at LifeOptions.org.

Why do I need to limit how much fluid I drink on dialysis?

Healthy kidneys control fluid balance in your body. When your kidneys lose the ability to control your fluid balance, dialysis can help remove excess fluid buildup.

Taking too much fluid off too quickly in a hemodialysis session can cause cramps and low blood pressure. This is one reason why it’s best to limit your fluid weight gain between treatments. In peritoneal dialysis (PD), your fluid limits will depend on how effectively fluid is removed by your exchanges.

Fluid overload can cause high blood pressure and shortness of breath. Over time, too much fluid can damage your heart by making it work harder.

Sticking to your fluid limits can be one of the most challenging part of taking care of yourself, but it’s very important to your well-being, both short- and long-term. Cutting way back on salt and other forms of sodium will help you feel less thirsty—but avoid salt substitutes. Eating ice instead of drinking water can help satisfy your thirst without taking in as much liquid. Try other ideas to see what works for you. Talk to your dietitian and ask other patients what they do. With resourcefulness, self-discipline and support from others, you can do it.

What can I do if I’m on dialysis and I’m thirsty?

Thirst is a common problem for people on dialysis, and if you are thirsty, it probably means you are trying to stay within your fluid limits. The good thing for you is this will help you stay healthier. Here are a few tips that other patients have used:

• Reduce salt in your diet. Salt makes you thirsty. Learn to read food labels to look for sodium content. Ask the dietitian how many milligrams of sodium you should have in a day.
• Bring a list of the medicines you take to a pharmacist and ask if any of them have thirst or dry mouth as side effects. If so, the doctor may be able to prescribe a different medication.
• Find some sour lemon hard candies to suck on.
• Put a spray bottle of a favorite beverage in the refrigerator. Spray it in your mouth for a cool rinse.
• Ask other patients how they deal with thirst.

What are phosphate or phosphorus binders and why do I need them?

Healthy kidneys remove excess phosphorus, a mineral that is present in many foods. Dialysis is not very efficient at removing phosphorus and too much in your system is harmful. High phosphorus stimulates overproduction of parathyroid hormone (PTH), which contributes to bone disease and can also cause itching.

Fortunately, phosphate binders (also called phosphorus binders) can help. Phosphorus binders are medicines taken within a few minutes of all meals and snacks. In your gut, they bind to phosphorus in your food to reduce the amount of phosphorus absorbed into your bloodstream. Reducing phosphorus in your diet and taking phosphate binders helps calcium stay in your bones, where it belongs.

Phosphate binders usually contain calcium. Calcium carbonate (Tums, OsCal, etc.) and calcium acetate (PhosLo) are common phosphate binders. Newer phosphorus binders without calcium are also available. Sevelamer (Renagel) is the most commonly used non-calcium phosphate binder.

Taking your phosphate binders is one of the most important things you can do to take good care of yourself.

What vitamins should I take or avoid on dialysis?

Everyone needs vitamins to maintain health, and most people get them from the foods they eat. Because there are diet restrictions on dialysis, dialysis patients need to make sure they are getting the nutrients they need for good health and usually need a special renal vitamin supplement. Talk to your doctor about your nutritional needs and ask if you need a prescription for a renal vitamin.

Water-soluble vitamins

Hemodialysis and peritoneal dialysis reduce water-soluble B and C vitamins. Renal diets also tend to be low in B vitamins and vitamin C. The easiest way to replace these vitamins without getting too much is by taking a special renal multivitamin once a day. Be sure to take it afterhemodialysis on treatment days.

If you take over-the-counter vitamins, read the label. Over-the-counter vitamins often have 1,000 percent to 2,000 percent of the RDA of some B vitamins — and these high doses could be toxic to someone whose kidneys don't work. Look for B vitamin levels of about 100 percent of the U.S. recommended daily allowance (RDA). The exceptions are two B Vitamins that help red blood cell formation: folic acid and vitamin B-6. These are recommended for dialysis patients at levels several times the RDA.

Limit vitamin C to about 60 mg per day. High levels of vitamin C can cause oxalate crystals to form in people with reduced kidney function.

B and C Vitamins	Amount	% of RDA
Vitamin B-1 (Thiamin)	1.5 mg	100%
Vitamin B-2 (Riboflavin)	1.7 mg	100%
Vitamin B-3 (Niacin)	20 mg	100%
Vitamin B-6 (Pyridoxine)	10 mg	500%
Folic Acid	1 mg	250%
Vitamin B-12 (Cobalamin)	6 mcg	100%
Biotin	300 mcg	100%
Pantothenic Acid	10 mg	100%
Vitamin C	60 mg	100%

Fat-soluble vitamins

Avoid vitamin A supplements. Because this vitamin is fat-soluble, not water-soluble, it can build up to higher than normal levels in people on dialysis.

Vitamin E is also fat-soluble and is not removed by dialysis. However, some nephrologists recommend 400 to 800 IU per day of natural-source vitamin E, because some studies have found that it can help dialysis patients. Ask your doctor if he or she recommends vitamin E for you.

Should I take a statin drug for my heart health on dialysis?

In 2003, the National Kidney Foundation put out guidelines on managing blood lipid levels in kidney disease. They recommend a target LDL cholesterol level of less than 100 mg/dL for people who have chronic kidney disease or are on dialysis. If you can't reach this target cholesterol level through diet and lifestyle changes, the guidelines suggest treatment with a statin drug — as long as you do not have liver disease.

Lipitor, Pravachol, Lescol, Mevacor and Zocor are statins available in the US. It's recommended that your doctor prescribe a low dose and slowly increase it to find the lowest dose that keeps your cholesterol at the target level.

Muscle pain (myopathy) is a possible side effect of statin drugs. Rarely, this muscle pain can be a sign of a serious problem called rhabdomyolysis, where muscle breakdown occurs and toxic waste products are produced. The chances of having myopathy are increased if you:

• Have kidney disease
• Take the antibiotics erythromycin, clarithromycin, or azithromycin
• Take antifungal drugs
• Take calcium-channel blocker blood pressure medicines (for example, Cardizem and Norvasc)
• If you take SSRI-type antidepressants

If you have muscle pain or tenderness, stop taking the statin drug and ask your doctor to test your blood level of creatinine phosphokinase (CK).

What medication can help control my high parathyroid hormone (PTH)?

Keeping PTH in the target range (not too high and not too low) helps prevent bone problems that are common in kidney disease. If your blood level of parathyroid hormone (PTH) is too high, your doctor may prescribe a form of active vitamin D to help bring your PTH level down.

Active vitamin D and related drugs are available in several forms. The most common are calcitriol (Calcijex or Rolcaltrol), paricalcitol (Zemplar), and doxercalciferol (Hectorol). Your doctor may prescribe one of these drugs for you in an injectable form, or as pills.

With vitamin D treatment, sometimes blood calcium levels can become too high, so your blood calcium level must be checked. If high calcium levels are a problem for you, your doctor may switch you to a different vitamin D drug, change your phosphate binder to one that does not contain calcium or suggest other changes.

PTH, calcium, and phosphorus must all be monitored together as you and your dialysis care team work to manage your mineral balance and the health of your bones.

How can I adapt to the changes in my body on peritoneal dialysis (PD)?

Peritoneal dialysis (PD) is a lifesaving therapy you can do yourself at home. It offers many advantages such as control over your schedule and relaxed dietary and fluid limits; however, there are physical changes you should be aware of, including:

• A tube sticking out of your belly
• An increase in your waist size
• The tendency to gain weight from sugar in the PD fluid

The catheter tubing can be held in place with a special “PD belt” or by other means, so it doesn't look obtrusive or get in your way. The catheter should not interfere with most forms of exercise or sexual activity. You may feel self-conscience during intimacy at first; however, in time you may learn to accept it and then ignore it.

To compensate for the several hundred calories you absorb from dialysate per day, you will probably need to reduce your intake of sugars and fats. Regular exercise can also limit weight gain and help you feel good about yourself. Even if you don't gain much weight, you should expect to need clothing that is a bit bigger in the waist.

The best way to accept the changes that come along with PD is to remember the benefits of this lifesaving therapy. -davita.com