Q: My brother suffers from kidney failure. He is on epoetin alpha and zemplar. It seems like everything I read about these drugs are counter-productive to what is beneficial to helping the kidneys, especially when my brother also has heart problems. What are they and why are they necessary?
A: Let’s take things a step at a time. The purpose of the kidneys is to filter waste and excess fluids from the blood. Those fluids leave the body through the urination process. Symptoms may be minimal in the early stages of the disease; however, with advancement, dangerous levels of electrolytes, fluids and waste can build up in the body. The patient may suffer from changes in urinary output, chest pain if the fluids build up around the heart lining, shortness of breath if fluids build up in the lungs, hypertension, swelling of the lower extremities, nausea, vomiting, and a great deal more. Since most of these signs and symptoms can also be the result of countless other conditions, a physician may find it necessary to perform specific testing to rule out some issues and concentrate on others.
Complications of the disorder may include pericarditis (inflammation of the membrane that envelops the heart), anemia, hyperkalemia (a rise in potassium levels in the blood which can affect the functioning of the heart), fluid retention in the extremities, pulmonary edema (fluid in the lungs), hypertension, damage to the central nervous system, and more. Diagnosis may be made through lab testing that includes blood and urine, ultrasound to determine the kidneys’ size and structure, and biopsy to help determine the cause of the failure. Treatment will depend on the underlying cause since some forms of the disease can be treated, while others cannot and a person’s condition can continue to worsen until those conditions that can be treated are brought under control.
Epoetin alpha is an injectable drug prescribed in dialysis patients, for anemia from chronic kidney disease in non-dialysis patients (untreated severe anemia has serious consequences), as well as for a number of other conditions. This protein substitute is normally made in the body by the healthy kidney and causes bone marrow to produce oxygen-carrying red blood cells. Clinical studies have shown that epoetin alfa may increase the risk of developing blood clots, stroke, heart failure and heart attack. I can only interpret that your brother’s nephrologist and/or cardiologist feels the benefits of this medication outweigh the risks but that is a question best presented to his prescribing physician.
Zemplar (paracalcitrol) is a manufactured form of vitamin D available in oral and injectable forms. It is prescribed to treat secondary hyperparathyroidism in individuals with chronic kidney failure. Its function is to block the formation and release of parathyroid hormone within the body. If phosphorus levels are not corrected prior to using Zemplar, it can lead to vascular calcification.
With your brother’s permission, accompany him to his next follow-up visit so your questions can be addressed. Only then will you both know why the drugs have been prescribed.
Other readers interested in learning more can order Dr. Gott’s Health Report “Kidney Disorders” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Peter H. Gott, MD Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.