Cough Management in Dialysis Patients

Identifying the Underlying Cause

Peritoneal dialysis patients have a 3-fold higher risk of chronic cough compared to hemodialysis patients, primarily due to gastroesophageal reflux disease (GERD) from increased intraperitoneal pressure 1, 2, 3, 4
ACE inhibitor-induced cough is a common cause of cough in dialysis patients, and switching to an angiotensin receptor blocker (ARB) is an acceptable alternative without the cough side effect 5, 1, 2, 3, 4
Pulmonary edema from fluid overload is a potential cause of cough in both hemodialysis and peritoneal dialysis patients 1, 2, 3, 4
Asthma/bronchospasm is a potential cause of cough in dialysis patients, with 40% of peritoneal dialysis patients with cough having wheezing versus 16% without cough 1, 2, 3, 4
Infectious causes, such as tuberculosis, are more common in dialysis patients due to immunosuppression 1, 2, 3, 4

For ACE inhibitor-induced cough, switching to an angiotensin receptor blocker (ARB) is recommended 5
For GERD-related cough, initiating proton pump inhibitor therapy twice daily and considering reducing dialysate volume if feasible are recommended 6
For fluid overload, optimizing ultrafiltration during dialysis and considering diuretic therapy if residual renal function exists are recommended 1, 2, 3, 4, 6
For asthma/bronchospasm, avoiding beta-blocking medications and initiating inhaled bronchodilators and corticosteroids as appropriate are recommended 1, 2, 3, 4, 5

Not using erdosteine as first-line therapy without identifying the underlying cause of cough, as this delays appropriate treatment of potentially serious conditions 1, 2, 3, 4
Not switching from ACE inhibitors to ARBs if cough is present 5
Not evaluating for infectious causes, such as tuberculosis, which require specific antimicrobial therapy 1, 2, 3, 4
Not assuming all cough in dialysis patients is benign, and evaluating for pulmonary edema, which can be life-threatening 1, 2, 3, 4