Page 36 - Beaumont_Book_1
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        EPO is extremely effective at increasing your blood count. However, in order for the EPO to work effectively
        your body needs to have enough iron. It is difficult for your body to take in enough iron through regular
        diet for the EPO to reach full effect. Your doctor may prescribe oral iron. Iron tablets can be a little
        unpleasant to take as they may make your stomach upset or cause you constipation. Iron tablets will also
        make your bowel movement
        black and tarry.
           If you cannot tolerate iron
        tablets    or   your    doctor
        determines, by blood test,
        that you are still low in iron,
        you    may    be    prescribed
        intravenous iron. If you are on
        haemodialysis, you will be
        given iron directly into the
        dialysis circuit.
           If you are on home dialysis
        or not on dialysis, you will
        need to come to Renal Day
        Care, 3rd Floor, for infusions of
        iron treatment. Intravenous
        iron is a safe drug but there is an occasional occurrence of an allergic reaction. So, before you get the first
        dose, you will generally receive a test dose (small dose).

           As we discussed under Vitamin D, your parathyroid glands are four small glands in your neck that
        control the level of calcium in your blood. In kidney disease, parathroid (PTH) hormone tends to
        increase. When this happens, it can have a number of effects, including weakening of your bones
                                                                      and causing pain in your bones and
                                                                      joints. In the first instance, your doctor
                                                                      may give you vitamin tablets (Rocaltrol or
                                                                     One Alpha); however, if these do not
                                                                     work, it may be necessary to receive
                                                                     Vitamin D intravenously (Zemplar) directly
                                                                    into the dialysis machine. If these
                                                                    strategies are not adequate, your doctor
                                                                    may advise you to take another drug called
                                                                   Cinacalcit (Mimpara). This drug is extremely
                                                                   effective at lowering PTH level. The main
                                                                   side effect of Cinacalcit is that it may cause
                                                                  a little nausea after it is taken. This,
                                                                  generally, settles down after a few days.
                                                                     Occasionally, if these drugs are not
                                                                 effective in controlling your PTH level, your
                                                                 doctor may recommend an operation to
                                                                 remove part of your parathyroid glands (a

        P.34 Kidney Disease — A Guide for Patients
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