Lifestyle Changes

When I start dialysis, will I still need to take pills?
There are a number of pills you need to take when you have kidney disease, and you will still need most of them on dialysis. Your blood pressure pills may change, and you may be able to get some of your medicines through the dialysis tubing instead of taking pills. Your physician will prescribe the medications you need, and make any changes required. Please discuss your medications with your physician if you have questions.

Can dialysis cause hair loss?
People who start dialysis do sometimes notice hair loss. It is usially temporary, and the hair will begin to grow again in a few months. A hair stylist may be able to make some suggestions about how to look good in the meantime. You can download a fact sheet on Skin and Hair by clicking: Skin and Hair Problems on Dialysis.

Why do I need to limit how much fluid I drink on dialysis?
Healthy kidneys control fluid balance in your body. When your kidneys lose the ability to control your fluid balance, dialysis can help remove excess fluid buildup.

Taking too much fluid off too quickly in a hemodialysis session can cause cramps and low blood pressure. This is one reason why it's best to limit your fluid weight gain between treatments. In peritoneal dialysis, your fluid limits will depend on how effectively fluid is removed by your exchanges.

Fluid overload can cause high blood pressure and shortness of breath. Over time, too much fluid can damage your heart by making it work harder.

Sticking to your fluid limits can be one of the most challenging parts of taking care of yourself, but it's very important to your well-being - both short- and long-term. Cutting way back on salt and other forms of sodium will help you feel less thirsty-but avoid salt substitutes. Eating ice instead of drinking water can help satisfy your thirst without taking in as much liquid. Try other ideas to see what works for you. Talk to your dietitian and ask other patients what they do. With resourcefulness, self-discipline, and support from others- you can do it!

What can I do if I'm on dialysis and I'm thirsty?
Thirst is a very common problem for people on dialysis. If you are thirsty, it probably means you are trying to stay within your fluid limits. Good for you, this will help you stay healthier! Here are a few tips that other patients have used:

Reduce salt in the diet. Salt makes you thirsty. Learn to read food labels to look for sodium content. Ask the dietitian how many milligrams of sodium you should have in a day.
Bring a list of medications to a pharmacist and ask if any have thirst or dry mouth as side effects. If so, the doctor may be able to prescribe a different medication.
Find some very sour lemon hard candies to suck on.
Put a spray bottle of a favorite beverage in the refrigerator. Spray it in your mouth for a cool rinse.
Ask other patients how they deal with thirst.

What are phosphate binders, and why do I need them?
Healthy kidneys remove excess phosphorus, a mineral that is present in many foods. Dialysis is not very efficient at removing phosphorus, and too much in your system is harmful. High phosphorus stimulates overproduction of parathyroid hormone (PTH), which contributes to bone disease and can also cause itching.

Fortunately, phosphate binders can help. Binders are medications taken within a few minutes of all meals and snacks. In your gut, they bind to phosphorus in your food to reduce the amount of phosphorus absorbed into your bloodstream. Reducing phosphorus in your diet and taking phosphate binders helps calcium stay in your bones where it belongs.

Phosphate binders usually contain calcium. Calcium carbonate (Tums®, OsCal®, etc.) and calcium acetate (PhosLo®) are common phosphate binders. Newer phosphate binders without calcium are also available. Sevelamer (Renagel®) is the most commonly used non-calcium phosphate binder.

Taking your phosphate binders is one of the most important things you can do to take good care of yourself.

What vitamins should I take or avoid?
Water-soluble vitamins. Hemodialysis and peritoneal dialysis reduce water-soluble B and C vitamins. Renal diets also tend to be low in B vitamins and vitamin C. The easiest way to replace these vitamins without getting too much is by taking a special renal multivitamin once a day. Be sure to take it after hemodialysis on treatment days.

If you take over-the-counter vitamins, read the label. Over-the-counter vitamins often have 1,000% to 2,000% of the RDA of some B vitamins-and these high doses could be toxic to someone whose kidneys don't work. Look for B vitamin levels of about 100% of the U.S. recommended daily allowance (RDA). The exceptions are two B Vitamins that help red blood cell formation: folic acid and vitamin B-6. These are recommended for dialysis patients at levels several times the RDA.

Limit vitamin C to about 60 mg per day. High levels of vitamin C can cause oxalate crystals to form in people with reduced kidney function.


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