Managing Your Medications on Dialysis

Most people on dialysis take several medicines, and a few of them work differently from anything you will have taken before — some are timed to your meals rather than the clock, and some are deliberately held back on treatment days. This guide explains the pattern, so the instructions make sense rather than just being a list to follow.

Which medicines are timed around sessions

Your own prescription is set by your nephrologist, and what follows describes the common groups rather than what you personally should take. Never start, stop or change a dose based on general information — including this page.

Phosphate binders are the medicines most often misunderstood. Dialysis cannot remove all the extra phosphorus from your blood, and too much of it pulls calcium out of your bones, which over time makes them weak and easier to break. High phosphorus is also a common cause of persistent itching. Binders work by locking on to phosphorus in your food so that less of it is absorbed — which only works if they are taken with the meal, not before it or an hour after. Commonly used ones include calcium carbonate, calcium acetate, sevelamer and lanthanum carbonate.

Medicines for anemia are usually given at the center. Failing kidneys stop signalling the body to make enough red blood cells, so many people receive an erythropoiesis-stimulating agent, often alongside iron, to treat the resulting anemia.

Blood pressure medicines are the group most often adjusted around treatment. Because a session removes fluid, blood pressure can fall during it — so your team may ask you to delay a dose until after treatment on dialysis days. Follow their instruction on this specifically; it is not a general rule that applies to everyone.

You may also be prescribed a form of vitamin D, or medicines to control the parathyroid hormone that rises when phosphorus and calcium are out of balance.

Some medicines are removed from your blood by dialysis itself, which is why a few doses are scheduled for after a session rather than before. If you are ever unsure whether to take something on a treatment day, ring your center and ask rather than guessing.

Keeping one accurate, current list

Keep a single list, in one place, that you actually update. It is the most useful thing you can carry, and it matters most in exactly the situations where you are least able to recall details from memory.

For each medicine, record:

• The name, including the generic name — the same medicine is sold under several brand names
• The strength, and how many you take at a time
• When you take it, and whether it is with food
• Whether it is held or delayed on dialysis days
• What it is for, in your own words
• Who prescribed it and when it was last changed

Include everything, not only what the nephrologist prescribed: medicines from other doctors, anything you buy over the counter, herbal preparations, and vitamin or mineral supplements. Over-the-counter painkillers and supplements are a genuine risk in kidney failure — some are cleared by the kidneys, and some contain a great deal of potassium or phosphorus. They count, and they belong on the list.

Bring the list to every appointment and ask for it to be checked against the center’s records. Lists drift apart quietly after a hospital admission or a change made by another doctor, and the review is what catches it. A photograph of the list on your phone is a reasonable backup, but keep a paper copy in your wallet as well.

Questions to ask before any new prescription

Tell every doctor and every pharmacist you deal with that you are on dialysis, before anything is prescribed. Many ordinary medicines need a reduced dose in kidney failure, and some should be avoided altogether. A dentist, a surgeon and a doctor treating you for something unrelated all need to know.

Worth asking each time:

1. Is this safe for someone on dialysis, and does the dose need adjusting?
2. Should it be taken before or after treatment on dialysis days?
3. Does it interact with anything already on my list?
4. Does it contain potassium, phosphorus or a large amount of sodium?
5. How will we know whether it is working, and when should it be reviewed?
6. What should I do if I miss a dose?

If a medicine is causing a side effect you find hard to live with, say so rather than quietly stopping it. There is usually an alternative, and a medicine you have stopped without telling anyone is more dangerous than one that is not agreeing with you.

Your prescription is set for you specifically, and it will be adjusted as your results change. Bring your list and your questions to your next session — the nurses and your nephrologist would rather spend ten minutes going through it than discover a problem later.