Some kidney functions must be replaced by drugs
Dialysis may perform most of the kidneys’ vital functions but it can not entirely replace the natural organ. For this reason, patients with chronic kidney failure must also take drugs to control e.g. the balance of minerals in the body and prevent a lack of red blood cells (anemia). Fresenius Medical Care produces and markets selected medications for the treatment of chronic renal patients and will continue to expand its product portfolio.
Erythropoietin and iron
Healthy kidneys produce the hormone erythropoietin (often shortened to “epo”), which stimulates the production of red blood cells in the bone marrow. These play a key role in the delivery of oxygen to tissues in the body. If the body does not have enough epo, it can lead to anemia. This often causes a drop in physical and mental performance and an increased risk for cardio-vascular diseases. To prevent anemia, chronic renal patients normally receive a drug that, like the natural erythropoietin, stimulates the production of red blood cells. Since iron is also needed to produce red blood cells, many dialysis patients also take iron preparations.
Phosphate is an important mineral found in many different foods from where it is absorbed via the gut. Phosphate plays as key role in metabolic processes as an energy carrier and is very important for the bone metabolism. Still, too much phosphate can also be harmful and, in healthy bodies, excess phosphate is excreted by the kidneys. In patients with chronic kidney failure, the excess phosphate remains in the body and causes the parathyroid gland to produce too much parathormone (secondary hyperparathyroidism). This hormone in turn causes bones to release calcium, making them weak and brittle. Additionally the calcium builds up in blood vessels and other tissue, causing amongst others a blocking of the arteries (arteriosclerosis). This leads to a higher risk for heart attacks and apoplexy.
To maintain phosphate levels in a certain range in dialysis patients, the
3 D's are used:
- Diet: Dialysis patients must eat foods low in phosphate.
- Dialysis: Phosphate is also removed via dialysis. But as for most of the dialysis patients diet and dialysis alone are not enough to lower high phosphate levels.
- Drugs have to be taken, which bind the phosphate before it is absorbed. These drugs are the so-called phosphate-binders, like Fresenius Medical Care's PhosLo or OsvaRen.
Active vitamin D (calcitriol) is a hormone normally produced by the healthy kidneys that controls the level of calcium in the body. In case of too low calcium concentration in the blood, vitamin D ensures that the intestines absorb more calcium from food. If the body lacks the vitamin due to kidney failure, it usually also suffers from a lack of calcium. To offset this, the parathyroid gland – as with increased levels of phosphates – produces more parathormone to release calcium from the bones. Vitamin D is taken to counteract this chain reaction.
In hemodialysis, the blood must be prevented from coagulating outside the body so anti-coagulants, such as Heparin, are added by the dialysis machine.
For more information about renal pharmaceuticals, please visit the Renal Pharma website of Fresenius Medical Care.
For more information about kidney patient care, please visit the UltraCare website of Fresenius Medical Care North America.