Which Specialist to Consult for Low Alkaline Phosphatase and Anemia?

Which specialty should I see?

Hello:
Problem description: I have been on dialysis for five and a half years, and my alkaline phosphatase levels have consistently been below 30, which is quite low.
Online searches suggest a connection with anemia, and it is recommended to consult a physician since this cannot be increased through diet.
I also have a long-standing issue with anemia, and I have reached the limit for EPO injections covered by health insurance, with blood transfusions as a necessary option.
My nephrologist has suggested the use of L-carnitine, which I have not yet accepted.

I would like to ask:
1.
What are the effects of low alkaline phosphatase levels on the body?
2.
Would increasing hemoglobin levels be beneficial? (I have a low meat diet; if I increase meat consumption to boost hemoglobin, would that indirectly raise alkaline phosphatase levels? It seems that increased meat consumption might also raise toxin levels; is it worth it?)
3.
If I want to consult a physician, which specialty should I see?
Additionally, I would like to ask about the use of low-energy intravenous laser therapy for kidney patients.
I have heard it can cause thirst.
If economic concerns are excluded, is it worth weighing the pros and cons? (I have consulted with a rehabilitation physician, but I feel that they are unfamiliar with the conditions of kidney patients, so I would like to confirm its suitability here.) Thank you for your help! 😃

H, 40~49 year old female. Ask Date: 2016/10/11

Dr. Wang Weijie reply Internal Medicine

Hello, thank you for your message.
Regarding your question, laboratory medicine primarily utilizes various tools in the laboratory to assist in the assessment of health status and physiological functions in preventive medicine, as well as in the diagnosis, evaluation, treatment, and monitoring of diseases in clinical medicine.
It can also serve as a reference and evidence for physicians in diagnosing diseases.

Alkaline phosphatase (ALP) has a reference range of 34-104 U/L.
If there are issues with the bones (such as hyperparathyroid bone disease) or abnormalities in the liver and biliary system (such as bile duct obstruction or liver tumors), the levels may be elevated.
Conversely, in cases of malnutrition, abdominal diseases, or anemia, the levels may be decreased.
It is advisable to discuss your condition with the attending physician at the hospital.
Wishing you peace and health.

Sincerely,
Dr.
Wang Wei-Jie
Deputy Director, Taoyuan Hospital, Ministry of Health and Welfare

Reply Date: 2016/10/11

More Info

When dealing with low alkaline phosphatase levels and anemia, it is essential to consult the right specialist to address your concerns effectively. Given your history of dialysis and ongoing anemia, the most appropriate specialist to consult would be a nephrologist, who specializes in kidney health. They can provide insights into how your kidney function may be affecting your alkaline phosphatase levels and anemia. Additionally, a hematologist may also be beneficial, as they specialize in blood disorders and can offer targeted treatment options for anemia.

Understanding Low Alkaline Phosphatase Levels
1. Impact on Health: Low alkaline phosphatase (ALP) levels can indicate various health issues, including liver disease, bone disorders, or malnutrition. In the context of dialysis patients, low ALP levels might be associated with bone metabolism issues, particularly if there is an imbalance in calcium and phosphate levels. It is crucial to monitor these levels as they can reflect underlying conditions that may require intervention.

2. Relationship with Anemia: There is a connection between low ALP levels and anemia, particularly in patients with chronic kidney disease (CKD). Anemia in CKD is often due to a deficiency in erythropoietin (EPO), a hormone produced by the kidneys that stimulates red blood cell production. If your ALP levels are low and you are experiencing anemia, it is essential to discuss this with your nephrologist, as they can evaluate the underlying causes and recommend appropriate treatments.

Dietary Considerations
3. Increasing Hemoglobin Levels: Raising your hemoglobin levels can indeed help alleviate anemia symptoms. While increasing meat consumption can boost iron intake, which is vital for hemoglobin production, it is essential to balance this with your overall health. A diet rich in iron, vitamin B12, and folate is crucial for improving blood counts. However, if you have concerns about toxin accumulation from increased meat consumption, it may be beneficial to consult a dietitian who specializes in renal nutrition. They can help you create a balanced diet that meets your nutritional needs without overloading your system.

4. Indirect Effects on ALP: While dietary changes can influence hemoglobin levels, they may not directly impact alkaline phosphatase levels. It is essential to focus on a holistic approach to your health, considering both your dietary intake and any necessary medical interventions.

Seeking Medical Advice
5. Choosing the Right Specialist: As mentioned, a nephrologist should be your primary point of contact for issues related to kidney function and its impact on your overall health. If your anemia persists or worsens, a hematologist can provide specialized care for blood disorders. It may also be beneficial to have a multidisciplinary approach, where both specialists collaborate to address your anemia and low ALP levels effectively.

Low-Energy Laser Therapy
6. Considerations for Low-Energy Laser Therapy: Regarding low-energy laser therapy for kidney patients, it is essential to weigh the potential benefits against the risks. While some patients report improved symptoms, such as reduced pain or enhanced healing, the therapy can lead to increased thirst, which may be a concern for dialysis patients. If economic factors are not a barrier, discussing this treatment with your nephrologist is crucial, as they can provide insights into its appropriateness for your specific situation and monitor any potential side effects.

In conclusion, addressing low alkaline phosphatase levels and anemia requires a comprehensive approach involving the right specialists, dietary adjustments, and potentially new treatment options. Regular follow-ups and open communication with your healthcare providers will be vital in managing your health effectively.

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