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Q. CKD patient with high phosphorus content. Is dialysis required now?

Answered by
Dr. Krishna Somani
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Apr 08, 2016 and last reviewed on: Oct 09, 2018

Hello doctor,

My father is suffering from CKD for the past one year. His creatinine level is 11.05, urea is 144 and uric acid is 5.10. 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 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 constipation problem. I have attached his reports for your reference. Please help.

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#

Hi,

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 few questions.

  • What is his age? How is his appetite?
  • Does he feel nauseated or vomit? Is he losing weight and feels 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 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.

Investigations to be done:

Iron profile, ferritin and iPTH.

Probable diagnosis:

Chronic kidney disease (CKD) or end-stage renal disease (ESRD) due to possible diabetic nephropathy.

Treatment plan:

1. Continue your previous medications along with the tablet Revlamer 400 mg one tablet twice daily with meals.
2. Take Lactifiber two scoops at night.

Preventive measures:

Avoid all sorts of painkillers and alternative medicines containing heavy metals.

Regarding follow up:

Revert back after the investigations to a nephrologist online.---> https://www.icliniq.com/ask-a-doctor-online/nephrologist

Hi doctor,

He is 58 years old. He has started losing weight since two months. His weight was 66 kg two months ago, but now he is 57 kg, 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 fox nut seeds pudding and for 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 backache and shoulder pain. Please guide.

#

Hi,

Welcome back to icliniq.com.

  • This weight loss is quite significant. I suggest to make an arteriovenous fistula (AV) at earliest if not done.
  • Get a chest x-ray done.

Visit a dietician to follow this diet formula:

  1. Proteins 0.8-0.9 gm/kg/day.
  2. Calories 25-30 kcal/kg.
  3. Salt 4 g and low potassium diet (K).
  4. Low phosphate.
  5. Fluids matching urine output.
  • You can give him tablet Dulcolax (Bisacodyl) two tablets for relieving constipation.

For further information consult a nephrologist online --> https://www.icliniq.com/ask-a-doctor-online/nephrologist


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