Q: My father is 65 years old. He has chronic renal failure and is diabetic too. He has gone through dialysis thrice. He has a very bad cough. Whenever he sleeps, his cough increases. He had problems in breathing for which he was admitted to the hospital. But during cough, he has no breathing problem. The doctor has advised Alex sugar free, which was changed to Corex. But the cough doesn't seem to stop. It's very loud and bad. Please advise. After every dialysis he loses about 3-5 kg of weight. He weighed 80 kg some time back, but now he is 65 kg. He had CRF 2 years ago. His creatinine was 13.5 but during the last dialysis it was 10.5. His urea levels were 191 but now they are 185.

A:Nocturnal cough is a common symptom in various medical conditions such as asthma, post-nasal drip, gastroesophageal reflux disease, and chronic pulmonary oedema/heart failure (heart cannot pump blood adequately to the other organs of the body resulting in fluid in the lungs). Of these conditions, pulmonary oedema/heart failure is most commonly encountered in ESRD (End Stage Renal Disease) patients. Hence dialysis supportive care is offered to remove excessive fluid in addition to the toxins accumulated in the body as a result of kidney failure. Excessive fluid accumulation in the lungs can cause nocturnal cough though it is most often accompanied with a difficulty in breathing. A review of the limited information concerning your father's condition suggests that he has lost a significant amount of weight since starting haemodialysis, a reflection of the fluid removed during each dialysis session. This may point towards a probable underlying pulmonary edema which may have contributed to your father's nocturnal cough. However, your father needs a thorough evaluation by his nephrologist to rule out other common causes of nocturnal cough.