Many people feel that uremia is a disease, but Beijing Jingdong American
Hospital experts to tell you is not an independent disease uremia is progressive
chronic end stage renal failure, then what uremia When dialysis is good? we
still see specialists introduction.
When dialysis is best? From the perspective of the medical profession in
fact, neither is the sooner the better dialysis (dialysis prematurely did not
significantly improve the prognosis), nor is it as late as possible (too late
for dialysis patients prone to complications affecting life quality and
long-term survival), but the best time to select the best kidney dialysis.
Then how to choose the best time to do kidney dialysis? We know the usual
case, according to the degree of renal dysfunction, chronic renal failure can be
divided into four:
1, renal decompensation: Although this loss of renal reserve capacity, but
for the secretion of urine, discharge of metabolic waste, toxins and drugs,
regulate water and electrolyte and acid-base balance is still good, so no
special clinical manifestations, blood creatinine and blood urea nitrogen is
usually normal or mildly elevated sometimes.
2, azotemia: This term moderate renal damage, renal dysfunction concentrated,
there nocturia or polyuria, varying degrees of anemia, often azotemia, serum
creatinine, blood urea nitrogen levels. Clinically, accompanied by nausea, loss
of appetite and general mild discomfort. This period of protection, such as
neglect of renal function, such as the emergence of severe vomiting, diarrhea,
caused by hypovolemia, severe infection and the use of nephrotoxic drugs, etc.,
can cause rapid kidney function decline and failure.
3, renal kidney failure period (uremia preliminary): This period has been
severely impaired renal function, severe loss of renal reserve capacity, unable
to maintain the body's metabolism and water and electrolyte and acid-base
balance. Impossible to maintain a stable internal environment, resulting in
serum creatinine, blood urea nitrogen increased significantly dilute urine
concentration dysfunction, acidosis, sodium retention, calcium, high phosphorus,
potassium and other balance disorders performance. Can have significant anemia
and gastrointestinal symptoms such as nausea, vomiting, loss of appetite. May
also have neuropsychiatric symptoms, such as fatigue, inability to concentrate,
listlessness and so on.
4, uremia: This period is late chronic renal failure, that uremia, clinical
manifestations, symptoms become more pronounced, the performance of multiple
organ pipe failure, such as the gastrointestinal tract, nervous system,
cardiovascular, hematopoietic system, respiratory system, skin and metabolic
system imbalance. Clinically manifested as nausea, vomiting, irritability,
increased blood pressure, palpitation, chest tightness, not supine, breathing
difficulties, severe anemia, convulsions, and even severe cases can be in the
long-term coma. This period need to rely on dialysis to sustain life. Often due
to hyperkalemia, cerebral edema, pulmonary edema, heart failure and sudden
death.
From four, as long as the patient has renal failure to uremia shall be timely
initiation of dialysis therapy, specifically, is the best time to achieve the
following targets dialysis began: creatinine clearance less than 10 ml / (min ·
1.73m2), serum creatinine greater than or equal 8mg/dl may be considered when
starting dialysis, diabetes complications due to their earlier, more and more
serious and should be appropriate for early dialysis; creatinine clearance less
than 15 ml / (min · 1.73m2) when to start dialysis.
For absolutely no clinical signs and symptoms of uremia may be appropriate to
delay dialysis patients, but in no case, creatinine clearance less than 10 ml /
(min · 1.73m2) should begin dialysis. If nausea, vomiting and other symptoms of
uremia, but nor explain reasons other than uremia and conservative treatment can
not be alleviated, even if did not meet the standard of renal function should
also be prepared to consider dialysis. When acute heart failure, uremia
encephalopathy, severe hyperkalemia and acidosis and other serious complications
after drug treatment can not be effectively controlled, it is urgent dialysis
indications. In addition, for malnourished patients, despite positive
non-dialysis treatment is still not correct, should also consider starting
dialysis.
