Vitamin/Mineral Loss on Dialysis

Does anyone know if there is more vitamin/mineral loss with longer forms of dialysis?

It has been said that longer slower dialysis is better and cleans the blood better…which in most cases takes more of the Phosphorous out of the blood…something that is harder at 3x a week. The only thing that comes out qucker is fluid…if adjusted and balanced correctly electrolyte imbalance shouldn’t be a problem.

Now removing too much within a short time is a nono…harmful and even fatal sometimes.

I’ve been told that water soluable vitamins are lost through dialysis. So I am to take vitamin C and Bcomplex when I get off dialysis. Other minerals such as phosphorus and calcium are also taken out through dialysis. I am having trouble with my phosphorus being too low and calcium too high so I have stopped my calcitriol and eat all the high phosphorus foods I can. If it still stays too low I will be getting phosporus added in my dialysate.

In general with longer and/or daily dialysis there is more loss which is generally good so dietary limitations are greatly reduced or even eliminated as in my case. I basically have no dietary restrictions at all.

Cathy, do you take specially formulated vitamins for dialysis patients like NephroVite/Dialyvite or do you take regular off the counter vitamins?..also, a tip for all of you on dialysis…get affordable vitamins for dialysis patients at… http://www.nephrotech.com …look for RenaPlex/100 tabs for $8.00

Right now I am taking Neprovite, but I don’t see why you couldn’t take over the counter in the same doses. I already take so many pills, mostly vitamins (3 iron, 4 stool softeners, B6, B12 and folic acid, nephrovite, C, Q-gel coq 10, lovastatin (since dialysis made my cholesterol soar) and amitriptyline (which they are trying for my restless legs), that I like being able to take it in one pill. In case you are wondering why I also take C and B’s, the C is taken with the iron to help absorption and the Bs are taken to keep my homocystine in a normal range.

Always talk with your kidney doctor about any vitamins or minerals before you take them. Doses that would normally be OK for people with working kidneys may be too high or too low if you have kidney failure and are on dialysis.

The nutrition module of Kidney School (www.kidneyschool.org) has a chart of vitamins, what they do and how much you need. Although water soluble vitamins are washed out with dialysis, fat soluble vitamins (A, D, E, and K) can build to toxic levels in people on dialysis.

Anybody know where to get a better price for Nepro? Or any other alternatives for supplement drinks?

http://store.devinemedical.us/ros50632.html

You can order Nepro from Ross, the manufacturer, directly. Go to www.rosstore.com and enter in the search field “nepro.” You will find 24 cans for $70 (price includes standard shipping). They sell it in 3 flavors – cherry, butter pecan, and vanilla.

In addition to liquid supplements, like Nepro, there are bars and even cookies. Some dietitians recommend that patients buy powdered egg whites and add them to other food they’re eating to give them a higher protein diet at a very low cost. Some supplements may be available at relatively low cost from your local grocery store or discount store (Costco, Wal-Mart, etc.).

Before you drink or eat any nutrition supplement, ask your dietitian whether it is safe for people on dialysis. If your dietitian doesn’t know about that specific supplement, he/she can find out out for you. One thing that might help everyone at your clinic is to have a “tasting day” at the clinic with samples of supplements. This would let you and other patients see which ones you like before you buy 24 cans of a supplement you hate.

[quote="Gusam doing my research whether decreasing from 2.5 hours to 2 will help…or maybe dialyzing every 2 days without having 2 days off…just some thoughts…[/b

[/quote][/quote]

Gus am I confused?? I thought you did 6x a week dialysis, what do you mean by dialyzing every 2 days and having 2 days off?? I’ve found that my phosphorus got very low on daily, I now get to drink my beloved diet coke to my heart’s content, and I was instructed to up my potassium intake significantly and it always still tests in the low 4s, so with daily I’m not sure you have to worry too much about potassium.

I do, however, do 5 hours a day at a bfr of 300 so am probably getting more dialysis than you are at 2 hours a day, that might make a difference. What are you finding your pre and post numbers to be?

Cathy

[/quote]

Gus am I confused?? I thought you did 6x a week dialysis, what do you mean by dialyzing every 2 days and having 2 days off??

[b] Right now I do 6x a week doing 2.5 hours…however, my labs show that my Albumin and Phosporous is dropping considerably and am beginning to feel awful…and also coming to a point where I can’t tolerate 2.5 anymore…basicly I need some adjustments…some of the options am thinking of are…

  • Go from 2.5 to 2 and reduce BFR from 410 to 375
  • Dialyze 5x a week without having 2 days off…example: M-F…Sat:Off…then Sun-Thur…Friday:Off…Sat-Wed…etc
  • Dialyze every other day…in other words every 2 days…

But first am gonna try the supplements…[/b]

I’ve found that my phosphorus got very low on daily, I now get to drink my beloved diet coke to my heart’s content, and I was instructed to up my potassium intake significantly and it always still tests in the low 4s, so with daily I’m not sure you have to worry too much about potassium.

Seems I am ending up just like you! Prolly I need to stop taking Renegel…but really, I need adjustments…

I do, however, do 5 hours a day at a bfr of 300 so am probably getting more dialysis than you are at 2 hours a day, that might make a difference. What are you finding your pre and post numbers to be?

That’s alot of hours…are you a big person? I only average 125lbs…and I only use 15liters of dialysate, am currently running BFR at 410…labs are good and it looks like it’s sliding downhill rather quick…I’ve also noticed that dialyzing close between 2 times don’t mix…for example, having dialysis in the evening and then dialyzing next morning does not work well, should be at least 24 hours apart…I’d wanna try 48 hours apart… :slight_smile:

Cathy[/quote]

however, my labs show that my Albumin and Phosporous is dropping considerably and am beginning to feel awful…and also coming to a point where I can’t tolerate 2.5 anymore…basicly I need some adjustments…some of the options am thinking of are…

Are you taking off too much fluid?? How is your conductivity?? I’ve found the only times I don’t feel good are when I take off too much or when my conductivity is below 13.9 or so. Also to up your albumin you need to eat more protein, try protein bars, look for ones high in protein. How is your potassium, if low it not only is dangerous but makes you feel weak. I’ve found eating nuts is good for protein, potassium and phosphorus.

Seems I am ending up just like you! Prolly I need to stop taking Renegel…but really, I need adjustments…

My goodness, I was off ALL binders as soon as my phosphorus went low, so even with upping my phosphorus and eating lots of high phos foods I still have a normal level. So YES (with your units permission) stop all binders!!

That’s alot of hours…are you a big person?

Yes I am, but I don’t think that is the reason, I was supposed to be on 7-8 hours on nocturnal so they are trying to make the 5 hours equivalent to the 7-8 hours.

labs are good and it looks like it’s sliding downhill rather quick
.

What do you mean by that, I haven’t seen my blood work really change at all since the beginning when I first started. My pre dialysis creatinine is usually around 6, BUN around 40 and post at low 2’s and teens for BUN.

Gus there is conductivity I think with the NxStage the difference I think is it is determined by the dialysate fluid that you receive pre-mixed. Gus do you know if the fluid you get comes in different “flavors”? I mean different calcium or potassium concentrations? If your potassium is getting low one solution on a regular dialysis machine would be to raise the concentration of potassium in the bath. If your issues are conductivity that would relate to the sodium concentration in your bath; it might need to be adjusted.

I don’t totally understand how the NxStage works but I think it actually does hemofiltration as opposed to hemodialysis. I’d like to understand the difference more clearly but my understanding is hemofiltration removes waste from the blood via convection while regular machines use mostly diffusion to move wastes across their dialyzer membrane. So I imagine the NxStage must infuse the ultra pure dialysate at some point and then draw it off later in the process? Does anyone know how the NxStage works? Is it hemofiltration or hemodialysis?

So if you’re using 12 litters per treatment and the treatment is two hours long that must mean your dialysate flow rate is 100 ml/minute. Do I have that right? I don’t understand what the machine bases the treatment length calculation on, what info does the machine use to determin how long the run lasts?

With the NxStage are the mechanics the same as a regular macine? In other words there is the blood path going from the access through tubing/pumps/air chambers/air detectors to the dialyzer then back to the access. And there is a one way dialysate path that goes to the dialyzer and then to the drain. And the machine does not infuse dialysate into the blood path way as a matter of course. DOes that sound about right?

And if you are feeling like you have low blood pressure during treatment does the machine infuse the untrapure dialysate through the dialyzer?

Thanks for being our NxStage resource Gus.

Your doing a different machine at home and not NxStage…btw, what dialyzer are you using?

I am on the Fresenius 2008K using an F70 kidney.

Please don’t stop your binders without talking to your nurse, but we are with the same company, just different centers, and stopping binders was the first step, then the repeated the phosphorus in a week or so and when it was still low told me to up my phosphorus intake even more. It was in the normal level the next month and I will be doing my third month’s tests in another week and a half.