Hemo Dislysis

[htpi1543]

I am 78 yo , stage 5, and getting my fistula installed next week. I take BP meds, potassium binder, phosphorus binder with few other meds. I am not diabetic. My question is. Can HD remove potassium, phosphorus and sodium and lower my BP without meds?. I am very nervous. Your input will be highly appreciated. God bless you all.

[WimWalther]

Howdy there,

HD can remove K (potassium). I'm not aware that it can remove Na (sodium) or P (phosphorus) and while binders are given for P, I believe that the Na is down to diet.

Someone with more formalized knowledge needs to chime in on the Na / P question.

The binder for P is typically calcium acetate, though you can use extra- or ultra-strength Tums or equivalent, which is what I do.

Hope this is somwwhat helpful.

[Little-Nephron]

HD will remove Potassium and Sodium as well. However, it is very hard to control the sodium shifting between blood and dialysis fluid (dialysate) during the treatment.

Reducing dietary sodium intake remains the most important tool in improving blood pressure control.

You will also notice, if you have salty meal, during dialysis you will easily get cramps compare to reduce/no salt diet.

As for Phosphorus/Phosphate, it is much bigger than Potassium and Sodium. It will take longer time to remove ( 8-10 hours) which is not achievable in centre dialysis due to the time limit.

Unfortunately, all food we consume contains Phosphate. Some are very high such as nuts family. Higher phosphate in your blood is the main cause of the itchiness and it also will make your bone weaker.

Phosphate binder therefore is very important to take with food (at the same time with food , not after). It works by binding with the phosphate in the food and remove from your body when you defecate (poo).

If your sodium and fluid intake is under control the doctor may consider cut down some of the blood pressure meds. Especially, on dialysis day, it is preferable for you to have a higher blood pressure ( not below 100) , so the dialysis can proceed.

Low blood pressure is quite a problem for HD because during treating your blood pressure can drop dramatically. However, if your systolic blood pressure (first number) is usually over 180, it will depend on how your body response to dialysis. The doctor will need to review your medications once you on dialysis.

Hope this help

[htpi1543 in reply to Little-Nephron]

Hi little Nephron: thank you for your very informative response. God bless you.🙏🙏🙏🙏

[Petsurvivor]

Sticking to your renal diet and taking your meds along with dialysis is the combination to follow now. Working with your drs and monitoring your weekly/monthly lab results will let your drs know if you’ve done anything to reduce your meds. Don’t stop any meds until checking your labs with your dr/nutritionist at your clinic. Good luck!

[Darlenia]

Hello! My hubby has been on both in-center hemodialysis for around 3 months and then transitioned to peritoneal dialysis for around 9 months. With hemodialysis, generally potassium isn't cleared well. With peritoneal dialysis, generally phosphorus is the problem. So, with hemodialysis, like so many others, my husband was put on potassium binders. He simply took a binder when he couldn't avoid a meal with lots of potassium. Then, the same approach (a binder) was used for peritoneal dialysis where phosphorus was the issue. With both forms of dialysis, iron levels eventually drop significantly, so most get medication or injections and infusions to bring it back up. (Your kidneys are responsible for producing a hormone called erythropoietin (EPO), which your body needs to make red blood cells.) To replenish proteins and restore iron to the extent possible, your dialysis center will likely encourage you to eat proteins again of all types. And, as mentioned by others, your labs will show you the direction to take with your diet. You'll also have periodic visits by staff at the center to review outcomes. (The nephrologist dropped by my hubby's chair weekly.) In our experience, dialysis opened up more variety in our food choices. Anyway, this is simply a broad overview of how things turned out for us. You're wise in getting a basic idea of what you can expect; my hubby went into dialysis suddenly and unprepared.

[htpi1543 in reply to Darlenia]

I thank you all for very informative reply. God bless you all. Thanks

[Kaleah6]

Hemodialysis removes approximately 900 mg of phosphorus per treatment.Peritoneal dialysis removes approximately 300 mg each day.

However, even on a low phosphorus diet you are allowed up to 800‐1200 mg

of phosphorus each day so we use both phosphate binders and dialysis to keep

your phosphorus level within target.

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