Okay. Here is the deal. Labs are part of the process of doing PD. We can't ignore them. (Yes, sometimes I only pretend to care about them. But I know they matter.)
I'll give you a future post answering some of the oddball questions I had when I started doing PD in exchange for the chance to put some lab information in here. Deal?
As a PD patient, I have my labs drawn every month. That's the fussy part of the system in the US. My personal opinion is that the system is completely jacked up. I am smart, able to care for myself, and compliant with my treatment. Why they need to see me twice a month (clinic and Nephrologist) is beyond me and very inconvenient. If I choose a dialysis modality that encourages independence, why wouldn't you just give me a slip to see a phlebotomist every month and just call me if there's a concern? Honest thought: The PD system I have in the US sometimes treats me like I can't be trusted. And it's annoying.
However, it is infinitely better than hemodialysis and multi-week clinic visits. Believe that.
Moving on. Labs are related to what I eat, how well my dialysis works, and what medications I take. As you know, kidneys are miraculous filters and keep our bodies clean. Unless you are me. And they pooped out (so to speak) a long time ago. Now I have PD, dietary limitations, and medications to help my body function as well as it can. Maybe not as perfectly as a body with A+ kidneys, but pretty darn good.
I will give you an overview of the main laboratory concerns for PD patients. Your mileage may vary - this is what I get tested for every month. I am providing the "goal numbers." These are the lab values the nurses and docs would like to see each month. If my numbers are significantly higher or lower, we talk about what needs to be done to adjust them. Medication or diet. Possibly my PD prescription.
1. Albumin. This is a count of my protein stores. Having plenty of protein means you can heal more easily, prevent infections, and stay strong and energized. (Goal number: 3.5 or greater)
2. Potassium. Keeps the heart and nerves working well. Fruits and veggies help with this. (Goal number: 3.5 to 5.5)
3. Calcium Corrected. Healthy bones and heart need calcium. But not too much. (Goal number: 8.4 to 10.2)
4. Phosphorus. This is the tricky one. Because phosphorus is found in EVERYTHING DELICIOUS. The problem with dialysis patients is that we store phosphorus. And too much can cause bone disease, deposits in the heart, lungs, eyes, joints, and blood vessels. This is the lab value that most dialysis patients will be reprimanded about. Because, seriously, it's all about yummy foods. We are told to avoid dairy, beans, many starches, packaged foods like pancakes mix and biscuits, soda, nuts and seeds, chocolate, peanut butter, pizza... etc. So, do we? NO. We take a medication called "binders" to help grab on to the phosphorus and move it out of our bodies through the bowels. Binders could be an over-the-counter supplement or a prescription pill. Some folks need a little - some need a lot. It kind of depends on your diet. (Goal number: 3.0 to 5.5)
5. PTH Intact. Parathyroid hormone. If it is high, it can cause bone and heart disease. This works in direct relation to phosphorus. When your phosphorus numbers are good, the PTH tends to fall into line. You may need oral active Vitamin D to help this process along. (Goal numbers: 150 to 600)
6. Hemoglobin. Red blood cell count. If low, you might need a medication such as Epogen (epoetin alfa). Regular injections of this will stimulate red cell growth. I've been on it when I need it, off it when I don't. (Goal number: 10 to 12)
7. KT/V Total PD. This is a measure of the adequacy of your PD. It shows how well your body is being cleaned by dialysis. If you have adequate dialysis, you will probably feel better, eat better, have fewer hospitalizations and illnesses, and could potentially live longer. This is tested in the US every three months. (Goal number: 1.7 or higher)
There are other issues, such as iron and cholesterol, but these are also routinely addressed with a primary care physician.
So, what does all this mean? Whatever you want it to. When you start PD, you'll get a report with these lab items. You can talk to your nurse/doc about the values. They'll probably tell you the basics about how to get them in line if you are high or low on the values. And you can decide if and how you want to deal with them.
Your numbers are a little off here and there? Not necessarily life or death. Consistently, seriously, off labs? You might think about what you eat and how you take your medication. Everyone is different. And labs are not something to obsess over. The goal is to feel as good as you can each day. Do your best. Do what you can. And live your life.
Some people find that they enjoy changing their diets drastically to avoid the need for medication. Some people really aren't bothered by the lab values and live the way they want to. Your PD support staff will tell you all the possibilities and all the possible solutions regarding lab issues. They won't take over your life - they are a guide for better living. It is up to you what you want to do about them.
I'm not saying you should eat with abandon and not take your medications. I'm saying that you can use common sense and the best of your abilities to find a comfort zone with labs that works for you. My personal experience? I like good lab values. I gave up dairy. I take my binders. I do my best. But not every single day. I am a human being and, therefore, eat pizza once in a while. My lab values and numbers fluctuate every month. Because I am alive. And things change. I change. So I just do my best and am glad to have a chance to do my dialysis the way I want to and try to keep moving forward.
Labs are nothing to be scared of. They're just boring.
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