Hi XXXXXXX,

Thanks for posting your query on XXXXXXX

Some of the common causes for cough in a patient on dialysis(Haemo or Peritoneal) can be:

1. Asthma- old or newly developed.
2. Any infection like pneumonia, tb, others.
3. Heart failure.
4. Gastro Esophageal Reflux Disease(GERD)
5. Pleural Effusion.
6. Upper Respiratory Tract Infection.
7. Sinusitis and Post Nasal Drip.
8. Certain medicines taken for control of BP.
9. Hypersensitivity to the dialysis membrane.

If some more history was forthcoming, it would have been helpful. Is the lady concerned a known asthmatic or is she taking any medicine like ACE inhibitors for the control of BP?

I would like to advice that an x XXXXXXX chest or even a CT Scan chest should be done to rule out any lung pathology with special emphasis on tb as she is immunocompromised. A cardiologist should also rule out any heart problem.

In the mean while, she should be put on regular nebulization with salsol and budecort at 4 to 6 hrs interval. She should also be given inhaler medicine like seretide accuhaler/seroflo(combination of long acting beta agonists and a long acting inhaled steroid). She can continue taking montair and winolap. Give her a PPI like rabiprazole or esomeprazole once or twice a day to tackle GERD if present(Very common occurence). If symptoms still persist, she may be given a short course of oral steroids like omnacortil 20 mgm a day for 5 to 7 days. I`m sure she will improve with these. If investigations show any underlying pathology, that has to be attended to.

If despite all these measures, cough persists, then sensitivity to dialysis membrane has to be considered and you may have to consult her nephrologist for change in the type of dialysis membrane.

I hope this answers your query and will be of help.

More on further inputs from you.

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