Patients with end-stage renal disease (ESRD) have kidneys that no longer function adequately. When we think about what the kidneys do for our bodies, removing excess fluid and waste products are the primary functions that come to mind. The kidneys also have other functions which are not as well known. They produce a hormone which signals the bone marrow to make red blood cells and remove excess phosphorus from the blood, thereby maintaining a healthy balance of calcium and phosphorus. Kidneys also have a role in activating vitamin D which promotes healthy bone formation and assist in regulating blood pressure.
Dialysis alone will not adequately manage long term kidney failure. Renal replacement therapy requires 3 major elements: some form of dialysis, dietary restrictions, and medications.
The dialysis treatment itself replaces many of the kidneys' functions. It will remove excess fluids and restore some of the blood chemicals to near normal levels. Proper diet is also important to control the build up of certain waste products. Finally, medications are needed to treat low blood counts, high blood pressure, high phosphorus levels, and low vitamin D levels.
Nearly all end stage renal disease (ESRD) patients have anemia, a reduced amount lack of red blood cells. Anemia due to ESRD is treated with medications called erythropoiesis-stimulating agents (ESAs). They mimic the natural hormone, erythropoietin, which helps the body produce red blood cells. The body needs extra iron to make red blood cells. Patients taking ESAs may need iron supplements. Typically given under the skin or as an injection, ESAs are administered in the vein during treatment at the dialysis clinics.
Blood Pressure Medications
When kidneys fail, they can no longer properly control blood pressure. Therefore, most patients with ESRD end up taking medications for this. Many types of medications are shown to be effective in lowering blood pressure in patients with kidney failure.
Elevated phosphorus levels are common in ESRD patients. High phosphorus levels lead to bone disease. According to published studies, having high phosphorus levels also increases the risk of death due to heart and vascular complications. Phosphorus-lowering medications, known as phosphate binders, work by absorbing phosphorus from ingested foods. There are many different types, some contain calcium, others do not.
Abnormalities of vitamin D, which can lead to bone disease, are common in ESRD patients . Under normal circumstances we get vitamin D from the sun, which our kidneys convert to an active form that our bodies can use. Damaged kidneys fail to do this, therefore patients with ESRD may need to take a special active form of vitamin D which is only available by prescription. Current research suggests that the administration of active vitamin D confers a survival benefit to patients with kidney failure in addition to supporting healthy bone formation.