Do any PD patients out there receive aranesp injections regularly? My dad (PD patient) does, every 10 days, I think. Do any of you know what the reason behind giving that drug is?
My dad has been experiencing shortness of breath with mild exertion and swelling of his legs and ankles for quite some time (since he started receiving these injections) and, upon researching, that particular drug, I found that it can cause these side effects. Has anyone else experienced this?
Thank you!
Hi Greeneyesinva,
Google can be your friend 
quick look for that drug gave many sites, most concise is this:
What is Aranesp?
Aranesp is a man-made form of a protein that helps your body produce red blood cells. The amount of this protein in your body may be reduced when you have kidney failure or use certain medications. When fewer red blood cells are produced, you can develop a condition called anemia.
Aranesp is used to treat anemia (a lack of red blood cells in the body).
Aranesp may also be used for purposes other than those listed.
Further down on that site are symptoms which you mention. As with alot on the net read with some care and back up with your doctor rather than taking everything online as gospel.
In another post Dori recommended: http://www.rxlist.com - to look up drugs.
Hope that helps
Aidan
I will say re swelling of legs outside of any drugs - my wife can get this and also swelling around eyes if not dialysed right - as far as I know - water retention.
Again Im sure Dori or others will be on are are more capable to answer these questions
Aidan
You guys are good! I love it when folks can help each other. 
Aranesp is a replacement of a hormone (erythropoietin) that healthy kidneys make.
Shortness of breath can be a symptom of anemia itself–and a sign of not getting enough dialysis to remove all the fluid. Leg swelling can also be a sign of not getting enough dialysis.
So, it can be tricky to figure out what is causing a certain problem. It could be the drug, but since it’s just putting something back into the body that was there before, it’s probably more likely that your dad started taking the drug around the time he started doing dialysis.
How is his blood pressure? Are his PD drains good? Is he reaching his dry weight after his exchanges? I’m worried that your dad has too much fluid “on board” (inside and between his cells) that is not getting removed.
Thank you, Aidan. Will check out Dori’s recommended site as well.
Dori:
Yes, he just started the aranesp after beginning dialysis. He has lab work run twice a month and his figures have all been good lately. He has had problems off and on with low sodium and magnesium but not at the moment. Dehydration has been an issue he has struggled with as well.
His BP ranges, within a day, between 130/70 to 74/49; that’s why his dr. put him on medrodine–to boost the BP and even it out. Just prior to starting PD, his dr. took him off his BP meds (September 2007). His nurse told him that with the dialysate in, he should weigh 149 lbs. but he can’t seem to stay under 154. My dad is the perfect patient; he does everything (and, I mean everything) that any dr. tells him to. He expected more from PD and feels that his quality of life most of the time is poor; he wants better and is willing to do whatever it takes to get there. It’s just that the drs can’t figure out what will do that for him.
His nurse suggested going to all 4.25% dialysate (he dialyzes 4 times a day), but both my dad and I are concerned about taking too much fluid off at once and messing up his electrolytes as a result. I suggested that he wait to do that until we actually visit the dr. next week. It just seems a bit abrupt to change immediately like that to something so dramatic.
Have you ever heard of a combination therapy–hemo AND PD? I was reading a medical journal article about it and it sounds like something we might like to learn more about. That’s the first time either my dad or I had heard of that.
Again, thank you for your help!!
Eileen
[QUOTE=greeneyesinva;16179]Have you ever heard of a combination therapy–hemo AND PD? I was reading a medical journal article about it and it sounds like something we might like to learn more about. That’s the first time either my dad or I had heard of that.
Again, thank you for your help!!
Eileen[/QUOTE]
Hey Eileen,
All I can say - GREAT MINDS THINK ALIKE
This very thing of Combined Therapy - Over the last few days i have been thinking about this - Is it possible? Say One day on Haemo and then the rest on PD. Seems a logical type mix to me.
The reason my mind works like this and combined seemed obvious to me - I own a small computer company revolving around Internet and Internet security - networks etc. From this I have learned its all about thinking outside the box and trying things … and not being afraid to do so. Discovery basically.
I too am interested if this is possible or useful!
Cheers
Aidan
Relative to combined modality:
http://www.pdiconnect.com/cgi/content/abstract/23/2/157
“CONCLUSION: Hemodialysis and PD are not mutually exclusive. They can be used in combination to achieve targeted solute clearances, to improve certain clinical conditions, and to control volume and blood pressure in a subset of patients. Further evaluation is needed to better establish the long-term outcomes of using combined modality. Total solute clearance goals and methods for determining total solute clearance need to be standardized.”
AND THIS:
"The combined therapy was well tolerated, and symptoms related to uremia improved in all six cases. Additionally, improvements in quality of life (QOL) were documented in all patients who were managed with the combined therapy. "
ALSO:
http://www.advancesinpd.com/adv00/Combined00.html
“We postulated that, for CAPD patients who are unable to achieve adequate solute clearance or volume control following optimization of their PD prescription, adding one hemodialysis session in conjunction with PD therapy (PD+HD therapy) would improve QOL.”
The reason I was interested is - IF my wife had to go back on Hemo Dialysis full time - it reduces quality of life. If however one could augment the PD with one session of Hemo to get more consistent dialysis - then … how bad!
Aidan
Hey Dori,
Maybe the last posts are steering off topic a little so move the latter to a new thread/message maybe? I think it is very interesting … maybe to others also?
Just a thought …
I should say that my wife is 37 and I am 44 - us of the net generation, just about – thinking this way
Aidan
Hi y’all,
I can’t tell you how happy I am to see the PD Board hopping! The kinds of questions you guys are asking and the answers you’re finding are really impressive. Lots of nice out-of-the-box thinking going on here. Great work! 
Back to the question Eileen asked about leg swelling, although fluid removal through dialysis is the most common culprit, there may be other causes.
– How’s your father’s albumin level? If his albumin is low this can contribute to leg swelling. Low albumin commonly happens to patients on PD if they don’t eat enough high biologic value protein (ask the dietitian sources) to offset what the dialysate removes. As I understand it, using 4.25% PD solution will remove more protein with the extra fluid plus using it too much can scar the lining of the peritoneum making PD not work well.
– Does he have congestive heart failure? If so, that can cause leg swelling. CHF can improve as PD removes the excess fluid that may have accumulated around the heart and may be keeping the heart from pumping like it should.
– What dialysate concentration is he using now – 1.5%, 2.5%? Did the nurse suggest the possibility of doing 5 exchanges a day or using the cycler at night to do dialysis instead of doing CAPD?
– How is his catheter working? How much fluid is he draining out compared with the amount he’s putting in? Most CAPD patients use 2 liter bags of dialysate.
Addressing the question about whether HD can be used to supplement PD, the answer is yes if someone has a permanent or gets a temporary vascular access. The Medicare Claims Processing Manual that addresses issues related to ESRD facilities can be found at http://www.cms.hhs.gov/manuals/downloads/clm104c08.pdf and it describes coverage as follows:
[I]50.6.1 - Payment for In-Facility Maintenance Dialysis Sessions Furnished to CAPD/CCPD Home Dialysis Patients
(Rev. 1, 10-01-03)
A3-3644.1, 3171.1
Although CAPD and CCPD patients are home dialysis patients, it may be necessary at times to dialyze them in-facility as a substitute. In this case, the total weekly reimbursement to the facility remains the same regardless of the type and frequency of infacility dialysis involved. In order to furnish covered CAPD services, a facility must be a Medicare approved ESRD facility and must meet additional standards established by CMS.
However, in rare instances an ESRD patient may require a combination of dialysis techniques, on the same day, in order to achieve satisfactory results. In these situations, Medicare pays for both types of dialysis services furnished on the same day. Medicare FIs [payers called fiscal intermediaries] to determine the medical necessity. In each case the FI obtains medical documentation from the facility that supports the use of back-up dialysis with another treatment modality. If a CAPD patient frequently requires back-up sessions, the FI’s medical staff may request medical records to determine if this is the appropriate mode of treatment to meet medical necessity requirement for payment purposes and/or whether a different
mode of treatment is more advantageous to the beneficiary.[/I]
[QUOTE=Beth Witten MSW ACSW;16213]Back to the question Eileen asked about leg swelling, although fluid removal through dialysis is the most common culprit, there may be other causes.
– How’s your father’s albumin level? If his albumin is low this can contribute to leg swelling. Low albumin commonly happens to patients on PD if they don’t eat enough high biologic value protein (ask the dietitian sources) to offset what the dialysate removes. As I understand it, using 4.25% PD solution will remove more protein with the extra fluid plus using it too much can scar the lining of the peritoneum making PD not work well.
– Does he have congestive heart failure? If so, that can cause leg swelling. CHF can improve as PD removes the excess fluid that may have accumulated around the heart and may be keeping the heart from pumping like it should.
– What dialysate concentration is he using now – 1.5%, 2.5%? Did the nurse suggest the possibility of doing 5 exchanges a day or using the cycler at night to do dialysis instead of doing CAPD?
– How is his catheter working? How much fluid is he draining out compared with the amount he’s putting in? Most CAPD patients use 2 liter bags of dialysate.
Addressing the question about whether HD can be used to supplement PD, the answer is yes if someone has a permanent or gets a temporary vascular access. The Medicare Claims Processing Manual that addresses issues related to ESRD facilities can be found at http://www.cms.hhs.gov/manuals/downloads/clm104c08.pdf and it describes coverage as follows:
[I]50.6.1 - Payment for In-Facility Maintenance Dialysis Sessions Furnished to CAPD/CCPD Home Dialysis Patients
(Rev. 1, 10-01-03)
A3-3644.1, 3171.1
Although CAPD and CCPD patients are home dialysis patients, it may be necessary at times to dialyze them in-facility as a substitute. In this case, the total weekly reimbursement to the facility remains the same regardless of the type and frequency of infacility dialysis involved. In order to furnish covered CAPD services, a facility must be a Medicare approved ESRD facility and must meet additional standards established by CMS.
However, in rare instances an ESRD patient may require a combination of dialysis techniques, on the same day, in order to achieve satisfactory results. In these situations, Medicare pays for both types of dialysis services furnished on the same day. Medicare FIs [payers called fiscal intermediaries] to determine the medical necessity. In each case the FI obtains medical documentation from the facility that supports the use of back-up dialysis with another treatment modality. If a CAPD patient frequently requires back-up sessions, the FI’s medical staff may request medical records to determine if this is the appropriate mode of treatment to meet medical necessity requirement for payment purposes and/or whether a different
mode of treatment is more advantageous to the beneficiary.[/I][/QUOTE]
Good morning, Beth, and thank you so much for this information!! When we saw the doctor earlier this week, I asked him about combo treatment and he said that Medicare would not pay for it. I will be sending him the information copied from the Medicare Payment Manual.
To answer your questions…my dad’s albumin level has been fine all along (3.6 last week); he doesn’t have congestive heart failure; he is using two 4.25% and two 2.5% daily and removing a net of 1300 (mL??) of fluid daily; it was suggested in passing that he use four 4.25% daily and possibly do 5 exchanges daily as well but the night cycler was ruled out due to the problems he is having with fluid buildup just doing daily exchanges; he does use 2 liter bags of dialysate.
The doctor basically said that CAPD is not working effectively for him and has advised that he try HD for 2-4 months with a catheter going from his jugular vein to his upper chest. The dr. said that he can keep doing CAPD as long as he wants–it’s his choice–but that it just isn’t effective and maybe his peritoneal membrane needs a rest. My dad had peritonitis last month in which case he could go back to PD after the 2-4 months.
Of course, there are a whole new set of problems–some of which he alread has (e.g., leg cramps and hypotension)–with HD and, initially, he felt that going to HD was the end of the line. I think he has reconsidered that opinion some, but I now he and my mom are both very concerned.
The pulmonary doctor found that he has some fibrous thing–don’t want to say mass or growth and can’t remember what he called it–that he explained was similar to a dried out sponge that needed to be re-hydrated. He wants to do another CT scan in a month and check it out; he said that there is a strong possibility that my dad’s cough could be caused by the diaylsate irritating his diaphragm as well as the scarring at the base of his lungs. If that’s the case, the coughing should improve when he is on HD if that’s what he decides to do in a couple of weeks.
I had asked the dr. about the other drugs to use in the treatment of hypotension (besides medrodine) and he dismissed them by saying that they were not nearly as effective. He cannot keep using medrodine, though, due to the side effects. Have you heard anything about drugs that would be as effective as medrodine minus the side effects (e.g., chills, sweats, urine retention). He is taking 2/3 dosage and cannot tolerate anymore than that and that amount has done nothing to control the BP.
Thank you, again, for answering my posts. You have been VERY helpful!!
On CAPD, the dialysis drain should be more than the amount of fluid in the bag. If your dad is using 2 L (2000 ml) of solution 4 or more times a day, but only removing 1300 ml a day, more fluid is being put in than is coming out. If so, his weight may be increasing. Has he gained weight recently?
I wonder if his PD catheter may have migrated so it’s not low enough in the abdominal cavity to remove the dialysate he puts in plus the fluid that he gets when he eats and drinks. This might make it appear that CAPD is not working well. It might be worthwhile asking the nurse or doctor to check to see if his catheter is where it should be? It’s possible to reposition a catheter if it’s not in where it should be.
His albumin level sounds like it’s pretty good, but patients do even better if they can keep their albumin level at 4.0 or higher. This is not easy to do on PD because the dialysate pulls off more protein than is removed with HD. He may want to ask the dietitian for ways to increase his albumin level.
I read about midodrine hydrochloride (ProAmatine). It mentioned the side effects you reported. It doesn’t look like this drug has been studied in patients with renal impairment from this description.
http://www.rxlist.com/cgi/generic/midodrine_wcp.htm
This very comprehensive article from Mayo Clinic discusses hypotension and shares information about about other treatments for hypotension besides midodrine. One non-drug recommendation is to wear compression stockings.
http://www.mayoclinic.com/health/low-blood-pressure/DS00590