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  1. #1
    Join Date
    03-10-06
    Posts
    275

    Question Use of NSAIDs on nocturnal with no kidney function

    Hello Dr. Agar,

    I have been on dialysis for almost 20 years now, no urine output, Hep C positive (initial stages of liver fibrosis), on daily nocturnal home hemo (6 nights a week, 7-8 hours each night).

    For the last couple of months, I have been having pain in my left knee (more at the back of the knee). X Rays showed Grade 1 Osteoarthritis. An MRI revealed a Baker's cyst an inflammation in the area with fluid collecting there. I was asked to take Indomethacin 25 mg twice daily. The pain subsided to a large extent. After about 3 weeks, I stopped taking this medicine 2 days back. Within 2 days, the pain was back to becoming unbearable.

    My doctor has advised to continue Indomethacin long term (a few more weeks).

    On the internet I read that NSAIDs are harmful but my doctor says that since I have zero kidney function, it would be ok for me to take. Are there any other side-effects for someone on Daily nocturnal that I need to be careful about? Maybe the liver? Or would this drug be effectively cleaned out during my dialysis (high flux).

    Thanks so much!

    - Kamal

  2. #2
    Join Date
    11-17-09
    Location
    Geelong, Victoria, Australia
    Posts
    461

    Default Re: Use of NSAIDs on nocturnal with no kidney function

    I fully agree with your doctor, Kamal. As you will have no residual renal function to fight for, nor to preserve, there is no contraindication to indomethacin here - beyond the usual cautioning that should accompany all NSAID use = take with food, and not on an empty tummy ... and to be alert to any dyspepsia that might signal upper GI erosive side-effects. I wouldn't be expecting any liver issues. So ... if it works, use it.

  3. #3
    Join Date
    03-10-06
    Posts
    275

    Default Re: Use of NSAIDs on nocturnal with no kidney function

    Thanks so much Dr. Agar for the quick response. It is a relief to know that I can use it.

  4. #4
    Join Date
    03-10-06
    Posts
    275

    Default Re: Use of NSAIDs on nocturnal with no kidney function

    Dr. Agar,

    Is osteoarthritis common among long term dialysis patients? Out of my almost 20 years on dialysis now, I have been on daily nocturnal home hemo for more than 10 years. Shouldn't that reduce the extent of co-morbidities?

    - Kamal

  5. #5
    Join Date
    11-17-09
    Location
    Geelong, Victoria, Australia
    Posts
    461

    Default Re: Use of NSAIDs on nocturnal with no kidney function

    As I hobble to my keyboard - just as common in dialysis patients as the rest of us. And, yes, nocturnal does lessen the severity of many of the blights of dialysis, but nothing prevents the march of years.

  6. #6
    Join Date
    01-16-14
    Posts
    2

    Default Re: Use of NSAIDs on nocturnal with no kidney function

    Quote Originally Posted by John Agar View Post
    I fully agree with your doctor, Kamal. As you will have no residual renal function to fight for, nor to preserve, there is no contraindication to indomethacin here - beyond the usual cautioning that should accompany all NSAID use = take with food, and not on an empty tummy ... and to be alert to any dyspepsia that might signal upper GI erosive side-effects. I wouldn't be expecting any liver issues. So ... if it works, use it.
    In the 4 years I have been on Dialysis my Primary Dr at the VA has changed, reduced, or quit some of medications because I am a 'Renal Patient'. I have under 4% Residual Function.

    This leads me to ask at what point do we determine if I may return to using some of these meds that are now 'restricted use'. I too had been using indosin for 30+ years, now reliant on pain meds including Tramadol which the dosage has been cut by half. Chantix worked well before, currently only allowed at half dose it does nothing.

    How can I convince my Primary Dr, my Neph agrees with me but will not go on record contrary to my Primary.

  7. #7
    Join Date
    01-16-14
    Posts
    2

    Default Re: Use of NSAIDs on nocturnal with no kidney function

    Quote Originally Posted by John Agar View Post
    I fully agree with your doctor, Kamal. As you will have no residual renal function to fight for, nor to preserve, there is no contraindication to indomethacin here - beyond the usual cautioning that should accompany all NSAID use = take with food, and not on an empty tummy ... and to be alert to any dyspepsia that might signal upper GI erosive side-effects. I wouldn't be expecting any liver issues. So ... if it works, use it.
    In the 4 years I have been on Dialysis my Primary Dr at the VA has changed, reduced, or quit some of medications because I am a 'Renal Patient'. I have under 4% Residual Function.

    This leads me to ask at what point do we determine if I may return to using some of these meds that are now 'restricted use'. I too had been using indosin for 30+ years, now reliant on pain meds including Tramadol which the dosage has been cut by half. Chantix worked well before, currently only allowed at half dose it does nothing.

    How can I convince my Primary Dr, my Neph agrees with me but will not go on record contrary to my Primary.

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