Medications While on Dialysis: Helping Improve Your Treatment Goals

By Kim Holdener, PharmD

There are three main medications that are routinely given to patients while on dialysis at WDI. Two of these, darbepoetin (Aranesp) and iron sucrose (Venofer), are used to treat anemia or low red blood cells. The third medication, paricalcitol (Zemplar), is a vitamin D supplement that is given to help with bone health. All three of these medications are important for your overall health and well-being while on dialysis.

People with kidney disease often develop anemia which means you have low red blood cell counts. This is because your kidneys produce a hormone erythropoietin (EPO) that tells your body to make red blood cells. When your kidneys do not work well, they do not make enough of this hormone and, therefore, your body does not have enough red blood cells.

Red blood cells are important because they carry oxygen around to different parts of your body and give you the energy you need for daily activities. Symptoms of anemia include feeling tired, shortness of breath, looking pale, fatigue, and having trouble concentrating. These symptoms can directly affect your quality of life. Anemia is also associated with increased risk of death and hospitalization for people with kidney disease.

You may receive two medications while on dialysis that help to treat anemia, darbepoetin and/or iron sucrose. Darbepoetin is a man-made form of EPO that is used to treat anemia. It is given intravenously (IV) once a week during hemodialysis treatments or as a subcutaneous (under the skin) injection every one to four weeks for people on peritoneal dialysis. Iron is also an important part of anemia treatment. This is because iron in your body is used to make new red blood cells.

If you do not have enough iron your body can not make red blood cells no matter how much darbepoetin you receive. For people on peritoneal dialysis, an oral iron supplement is often adequate. However, people on hemodialysis need intravenous iron because oral iron will not provide enough iron to keep iron levels where they should be. When iron levels are low, a "load" of IV iron is given in ten doses over ten dialysis sessions. When iron levels are normal, patients often receive a "maintenance" dose of iron once a week.

The third medication that may be given on dialysis at WDI is called paricalcitol and is used to treat bone disease associated with kidney disease. Paricalcitol is a vitamin D supplement. It is given to help lower parathyroid hormone (PTH) levels. PTH levels are part of the balance of phosphorus and calcium levels in your body. When these levels become abnormal, it affects your bone health and can cause osteoporosis-like symptoms. People who are on peritoneal dialysis often take this medication, or one like it, in a pill form.

All three of these medications that are given during dialysis treatments help to improve your health and quality of life. Your monthly lab report card has the results of your anemia and bone health labs. You can discuss these results with your nurse, nurse practitioner, dietitian, pharmacist or physician to see if they are meeting our treatment goals, and how these medications are adjusted to give you the best outcomes.