Does a CKD patient with high phosphorus need dialysis?
Patient's Query
Hello doctor,
My father has been suffering from CKD (chronic kidney disease) for the past year. His creatinine level is 11.05 mg/dl, urea is 144 mg/dl, and uric acid is 5.10 mg/dl. He has no swelling or breathlessness, but his phosphorus content is high, 5.80. We have not started the dialysis at the moment.
Could you please guide the right way of treatment? He is on Insulin, but his fasting sugar is 59, and his hemoglobin is 8.90 at the moment. Urine output is equal to input. His current medicines are these: Minipress 0.25 mg, Moxovas, Zyloric, and Arkamin.
He is having a constipation problem. I have attached his reports for your reference.
Please help.
Hello,
Welcome to icliniq.com.
After seeing all the details and your father's reports (attachment removed to protect patient identity). I would like to ask a few questions.
- What is his age? How is his appetite?
- Does he feel nauseated or vomit?
- Is he losing weight and feeling generally unwell?
With these reports, it is clear that there is no urgency to rush into dialysis, but it will be required soon. So, a fistula surgery should be done as soon as possible, as it may take some time to start working. Phosphorus (PO4) has to be controlled with diet and medicines.
Strict diet restriction of PO4 (800-1200 mg/day) can be done by sitting with a dietician. You can start with Tablet Revlamer 400 mg (Sevelamer), one tablet with meals twice a day. Ensure that blood pressure (BP) is in control. Do not give night doses of insulin if morning sugar levels are low.
Avoid all long-acting Insulins. Use only human Actrapid Insulin (HAI) for sugar control. For constipation, you can start Lactifiber two scoops with warm water at night. Hemoglobin (Hb) is low. So, check his iron profile, serum ferritin, and intact parathyroid hormone (iPTH), after which we can start some injections to increase Hb.
I hope this helps you.
Thank you.
Probable diagnosis
Treatment plan
Preventive measures
Patient's Query
Hello doctor,
Thank you for the reply.
He is 58 years old. He has been losing weight for two months. His weight was 165 lbs two months ago, but now he is 125 lbs, a drastic change in two months. He eats well. Morning, he takes tea and biscuits for breakfast, oatmeal and milk, or brown bread and milk.
For lunch, he will have boiled rice along with a vegetable (gourd). In the evening again tea and biscuits. Then after an hour, he will usually take a fox nut seeds pudding, and for breakfast, he will usually take porridge and a vegetable curry. His milk intake is only 200 mL per day. No nausea or vomiting as such except severe constipation. He is having a backache and shoulder pain.
Please guide.
Hello,
Welcome back to icliniq.com.
This weight loss is quite significant. I suggest making an arteriovenous fistula (AV) at the earliest, if not done. Get a chest X-ray done.
Visit a dietician to follow this diet formula:
- Proteins 0.8-0.9 gm/kg/day.
- Calories 25-30 kcal/kg.
- Salt 4 g and a low potassium diet (K).
- Low phosphate.
- Fluids match urine output.
You can give him tablet Dulcolax (Bisacodyl) two tablets for relieving constipation.
For further information, consult a nephrologist online.
I hope this helps you.
Thank you.
Same symptoms don't mean you have the same problem. Consult a doctor now!
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