What can be given to a patient with impaired renal function on dialysis for a cough, and what home remedies can be recommended?

Cough Management in Dialysis Patients

For a dialysis patient with cough, first identify and treat the underlying cause rather than simply suppressing the symptom—switch ACE inhibitors to ARBs if present, start twice-daily proton pump inhibitors for GERD (especially in peritoneal dialysis patients), optimize ultrafiltration for fluid overload, and use inhaled bronchodilators for bronchospasm. 1

Identify the Specific Cause First

The approach must be diagnostic rather than symptomatic because dialysis patients have distinct, treatable causes of cough:

ACE Inhibitor-Induced Cough

• Switch to an angiotensin receptor blocker (ARB) immediately if the patient is on an ACE inhibitor, as this is a common and reversible cause 1
• ARBs provide equivalent cardiovascular protection without the cough side effect 1

GERD-Related Cough (Most Common in Peritoneal Dialysis)

• Peritoneal dialysis patients have a 3-fold higher risk of chronic cough (22% vs 7% in hemodialysis) primarily due to increased intraperitoneal pressure causing gastroesophageal reflux 1, 2
• Among PD patients with persistent cough, 67% report heartburn versus only 29% without cough 2
• Initiate proton pump inhibitor therapy twice daily 1
• Consider reducing dialysate volume if clinically feasible 1

Fluid Overload and Pulmonary Edema

• Pulmonary edema can occur without peripheral edema in dialysis patients, particularly those with diastolic dysfunction or renal artery stenosis 3
• Look for orthopnea, jugular venous distension, hepatojugular reflux, pulmonary rales, and S3 gallop rather than relying on ankle edema 3
• Optimize ultrafiltration during dialysis sessions 1
• Consider diuretic therapy if residual renal function exists 1

Asthma/Bronchospasm

• 40% of peritoneal dialysis patients with cough have wheezing versus 16% without cough 1
• Avoid beta-blocking medications 1
• Initiate inhaled bronchodilators and corticosteroids as appropriate 1

Infectious Causes

• Dialysis patients have increased susceptibility to infections including tuberculosis due to immunosuppression 1
• Evaluate for infectious etiologies that require specific antimicrobial therapy 1

Home Remedies and Supportive Measures

For GERD-Related Cough

• Elevate the head of the bed by 6-8 inches 1
• Avoid eating within 3 hours of bedtime 1
• Reduce acidic, spicy, and fatty foods 1
• Maintain smaller, more frequent meals rather than large volumes 1

For Fluid Management

• Strict adherence to fluid restrictions between dialysis sessions 1
• Daily weight monitoring to detect fluid accumulation early 1
• Sodium restriction to minimize thirst and fluid retention 1

General Measures

• Humidify the air, especially in dry environments 1
• Stay well-hydrated within prescribed fluid limits 1
• Avoid irritants like smoke, strong perfumes, and chemical fumes 1

Critical Pitfalls to Avoid

• Never use erdosteine or other cough suppressants as first-line therapy without identifying the underlying cause, as this delays appropriate treatment of potentially serious conditions 1
• Never assume all cough in dialysis patients is benign—always evaluate for pulmonary edema, which can be life-threatening 1, 3
• Never continue ACE inhibitors if cough is present—switch to ARBs 1
• Never rely on the presence or absence of ankle edema to rule out pulmonary edema in dialysis patients 3
• Never overlook infectious causes like tuberculosis, which require specific antimicrobial therapy 1