From the Guidelines
Uremia symptoms are best managed through a combination of dietary modifications, medications, and dialysis, with a focus on maximizing quality of life and minimizing uremic complications, as supported by clinical practice guidelines 1.
Management Strategies
- Dietary modifications: low-protein diets, keto-analogs of essential amino acids, and restriction of potassium, phosphorus, and sodium intake are essential for managing uremic symptoms 1.
- Medications: loop diuretics, sodium polystyrene sulfonate, and other pharmacological therapies can help minimize uremic symptoms and maintain volume homeostasis 1.
- Dialysis: either hemodialysis or peritoneal dialysis is the primary treatment for removing waste products and excess fluid from the blood when the kidneys can no longer do so effectively.
Key Considerations
- Nephrologists should be familiar with the principles of palliative care and consider hospice referral for patients with advanced kidney failure 1.
- The initiation of dialysis therapy remains a decision informed by clinical art, as well as by science, and the constraints of regulation and reimbursement 1.
Symptomatic Treatments
- Antiemetics for nausea, gabapentin for uremic pruritus, and sodium polystyrene sulfonate for hyperkalemia are examples of symptomatic treatments that can improve quality of life 1. The goal of managing uremia symptoms is to improve quality of life and reduce morbidity and mortality, and this can be achieved through a comprehensive approach that includes dietary modifications, medications, and dialysis, as well as consideration of palliative care and hospice referral 1.
From the FDA Drug Label
Oral calcitriol capsules may normalize plasma ionized calcium in some uremic patients, yet fail to suppress parathyroid hyperfunction. In these individuals with autonomous parathyroid hyperfunction, oral calcitriol capsules may be useful to maintain normocalcemia, but have not been shown to be adequate treatment for hyperparathyroidism.
The management of uremia symptoms involves the use of calcitriol to maintain normocalcemia, but it may not be sufficient to suppress parathyroid hyperfunction.
- The dosage of calcitriol should be carefully determined for each patient, with regular monitoring of serum calcium levels.
- Dietary calcium intake should also be considered, with a minimum of 600 mg daily recommended.
- In some cases, calcium supplements may be necessary, but should be used with caution to avoid hypercalcemia 2.
- For patients with hyperparathyroidism, calcitriol may be useful to maintain normocalcemia, but other treatments may be necessary to address the underlying condition 2.
From the Research
Uremia Symptoms Management
Uremia symptoms can be managed through various methods, including:
- Dietary changes, such as low-protein diets, to reduce the buildup of toxins in the body 3
- Renal replacement therapy, which can help remove waste products from the blood and resolve symptoms such as gastrointestinal symptoms, pericarditis, and central nervous system alterations 4
- Treatment of underlying conditions, such as hypertension, and control of phosphorus, protein, and fluid and electrolyte levels 5
- Oral supply of essential amino acids, which can help improve the general condition of uremic patients and reduce the severity of symptoms 6
- Dietary fiber supplementation, which can help reduce plasma urea levels and alleviate some symptoms of uremia 7
Therapeutic Options
Therapeutic options for managing uremia symptoms are limited, but may include:
- Kidney transplantation, which can help restore normal kidney function and eliminate the need for dialysis 4
- Dialysis therapy, which can help remove waste products from the blood and manage symptoms, but may not be able to remove all toxins and can have limitations 4
- Medications to control underlying conditions, such as hypertension and anemia, and to manage symptoms such as nausea and vomiting 5, 6
Nutritional Management
Nutritional management plays a crucial role in managing uremia symptoms, including: