Dialysis can control the level of virtually all the substances in the blood, but phosphates can cause problems - they can build up and combine with calcium in the blood, and this mixture can cause damage by being deposited on the blood vessel walls. It can also cause itchiness and affect the strength of the bones and joints.

Phosphate levels are difficult to control through diet, as they are present in most foods. You will be given advice on how to lower your phosphate intake through diet, but drugs called Phosphate binders are likely to be prescribed in addition to this.

These prevent the absorption of phosphates into the bloodstream. They are usually calcium carbonate (chalk) tablets, or other calcium salts such as calcium acetate.

Sometimes, aluminium hydroxide gel or capsules are prescribed to bind phosphates. However, aluminium can have toxic effects if used on a long-term basis.

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Diuretics are used when there is too much water in the body. The tablets remove fluid by increasing the amount of urine that is passed.

(The problem of Fluid overload is described in What about fluid intake?)

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EPO (Erythropoietin) is one of the hormones manufactured by healthy kidneys. It stimulates the bone marrow to make red blood cells, which transport oxygen around the body. In kidney failure, the body cannot make its own EPO, and this leads to anaemia.

EPO is often prescribed, initially to correct anaemia, and sometimes (at a lower dose on an ongoing basis) to keep the red blood cell count up. Not everyone needs it, however. For instance, in kidney diseases where the kidneys remain large (such as in polycystic kidney disease) EPO production is not as severely affected.

If it is decided that you would benefit from commencing EPO therapy, you are likely to see the doctors and maybe an EPO Nurse Specialist who will discuss this with you, organise the prescription, and answer any questions you may have.

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Vitamins B and C are water soluble, so they can be lost during dialysis.

Vitamin D is associated with the health of bones. Damaged kidneys are unable to convert ordinary vitamin D for use in the body, so when vitamin D is prescribed, it is likely to be in its active form - which is called alpha calcidol.

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Constipation can be a problem, particularly for dialysis patients because their fluid intake is so restricted. If you are constipated, please talk to staff at your Renal Unit - don’t buy laxatives yourself from a high street chemist, as not all laxatives are suitable for renal patients.

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Content Last Updated: 18th May 2000.
Page Last Updated: 11th February 2005.