When To Start Dialysis Treatment

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.

Real Story : Can I Get Rid Of Dialysis

A 61 years old patient from Bobby New Guinea has got renal failure and done dialysis in his country for 10 months. He did dialysis 3 times per week and urine volume was 80ml per day.
You know he wanna live a healthy life and improve his quality of life, so with her daughter's help, he came to our hospital to treat his kidney disease on 8th of May in 2013.
On that day before he did hemoperfusion his creatinine level was 636umol/L  , after doing dialysis was 327umol/L .
On 12th May before he did dialysis his creatinine level was 495umol/L and after doing dialysis it was 233umol/L.
On 16th May before he did dialysis his creatinine level was 437umol/L and after doing dialysis it was 200 umol/L
On  24th May before he did dialysis his creatinine level was 285umol/L and after doing dialysis it was 142umol/L
On 29th May before he did dialysis his creatinine level was 242umol/L and after doing dialysis it was 115umol/L
On 3th June before he did dialysis his creatinine level was 218umol/L and after doing dialysis it was 96umol/L
On 9th June he has stopped dialysis for 6 days, his creatinine level is 204umol/L
On 12th June his creatinine level was 185 umol/L he has stopped dialysis for 11 days.
He will be discharged from our hosptial on 19th June and get rid of dialysis.
Not only him but also his family feel very happy.

Food List for dialysis patients

Dialysis involves cleaning the blood outside of the body; this is performed by a machine in hemodialysis or by regular fluid exchanges in peritoneal dialysis. Patients on both types of dialysis have to be careful about the foods they eat, although hemodialysis patients do not receive treatment every day, so they need to be even more careful. Phosphorus, potassium, sodium and fluid levels can increase in between dialysis sessions and can cause health problems.
Potassium-rich foods are limited for those on hemodialysis because potassium builds up between dialysis treatments and can cause problems such as weakness, muscle cramps, tiredness, irregular heartbeat and, worst of all, heart attack. Potassium is found mostly in fruits, vegetables and dairy products. Certain fruits and vegetables are very high in potassium while others are lower. However, eating a large amount of a low-potassium food can cause potassium to add up to dangerous levels. Be aware that most foods contain some potassium — meat, poultry, bread, pasta — so it can add up. Butter, margarine and oils are the only foods that are potassium free.(If you have question ,you can ask a doctor )
Once you start dialysis you may need to follow a high-protein diet made up of high-quality protein, because protein helps maintain muscles and tissues. High-quality protein leaves less residue for the kidney to have to process. High protein foods include meat, fish, chicken, turkey and eggs, especially egg whites.
Sodium levels can become elevated when the kidneys are not functioning properly, leading to fluid retention in between dialysis sessions, according to Baptist Health Systems website. Patients on dialysis should limit sodium intake to avoid this problem. Canned foods contain large amounts of sodium and should be avoided as much as possible.

Why Hemodialysis Have Low Blood Pressure

Most hemodialysis patients are complicated by cardiovascular and cerebrovascular diseases, let's take a look at the majority of hemodialysis hypotension reasons, but mainly has the following number of points;
1. Volume deficiency
The majority of hypotension during hemodialysis with an excess of dehydration to the sharp decline in blood volume in a very short period of time excessive ultrafiltration, causing the volume and cardiac output decrease may be due to the appearance of those conditions: (a) the amount of the error estimate for ultrafiltration; (2) more water for dialysis patients and overstatement weight; (3) poor venous vascular access, so that venous hypertension caused increased pressure dialysis, ultrafiltration volume is too more, causing a lack of blood volume, but also more common in dialysis before a blood volume deficiency, such as eating less, low sodium diet, nausea, vomiting, blood pressure medication and vasodilator agents treatment.
2. Long-term use low sodium dialysate
Dialysate sodium concentration lower than the plasma, resulting in lower serum sodium, plasma osmolality landing, body fluids into the cell, to hypovolemia.
3. Weight gain between dialysis clearly
 In the blood beyond the proper amount of timely landing weight before discount more than 5% of body weight, prone to low blood pressure, weight gain between dialysis therefore should be controlled below 4%.
4. Blood vessel function unstable dialysis patients
Atrial Britain, pericarditis, endotoxin, infection and bleeding easily lead to hypotension.
5. Autonomic function disorders
Hypotension caused by excessive ultrafiltration occurs mostly after 1 hour at the beginning of dialysis, ultrafiltration does not add a certain amount of liquid, the dialysis membrane and allergic toxin induced hypotension, then appeared earlier, these elements exist many kinds of , then the timing of hypotension increases.

Can Dialysis Cure Renal Failure

Chronic renal failure is kidney damage caused by various reasons progress in the performance deterioration of end-stage renal function close to the normal 10% or so, there was a series syndrome generally have relatively long duration.
The vast majority of patients with chronic renal failure, dialysis treatment is carried out. Dialysis is that it is a blood purification technology. Especially hemodialysis dialysis treatment, patients will rely on hospital dialysis equipment. Typically, patients must be every 2-3 days to the hospital for a dialysis, dialysis time to spend 3-4 hours, it also greatly reduces the quality of life of patients with chronic renal failure.
Hemodialysis membranes balance principle is based on the patient's blood through a kind of film many small holes, these holes can allow molecules to pass through it is smaller than, the diameter is larger than the membrane pore molecules are prevented from leaving, and the semi-permeable membrane and chemical composition containing dialysate will certainly touch. Dialysis, the patient's blood stream composed of half a small gap membrane, the dialysis fluid flow in the trailer bucket, red blood cells, white blood cells and proteins and other large particles can not be holes through the semi-permeable membrane; the water, electrolyte and metabolite in the blood, such as urea, creatinine, guanidine and other small substances can diffuse through the semipermeable membrane into the dialysis solution; the dialysis fluid substances such as bicarbonate or acetate, etc. can also diffuse into the blood, to remove harmful substances, complement The purpose of the body of material required.

How To Treat Peritoneal Dialysis Patients With Edema

In peritoneal dialysis, the volume overload can lead to high blood pressure, can cause or aggravate peritoneal dialysis patients with left ventricular hypertrophy, congestive heart failure and other cardiovascular complications. Since peritoneal dialysis is performed at home, need to rely on the judgment of the water balance to achieve the patient's own, the early symptoms of water retention is more subtle, can have no symptoms of limb edema, or just manifested as elevated blood pressure, easily overlooked.
A common cause of edema caused by
(1) Excessive intake of salt: sodium peritoneal dialysis itself scavenging low, especially in patients with fluid retention occurred when the more obvious. Many patients often because of thirst, or difficult to change the habits of the past, or understand the importance of controlling liquids and other reasons, unable to control salt intake, leading to edema. Once edema, are often more difficult to correct.
(2) Salt clear reduction: With prolonged peritoneal dialysis, residual renal function in patients with decreased or loss of the patient's peritoneal membrane function even if there is no change, the total water clear also due to the decrease of residual renal function decline. On the other hand, since the change in peritoneal transport, will lead to reduced clearance of the water. Coupled with increased lymphatic drainage, lymphatic reabsorption increased, resulting in patient volume overload, edema.
(3) the emergence of new complications: such as cardiac dysfunction or aggravate existing heart disease, hypoalbuminemia, mechanical or anatomical complications, so that peritoneal ultrafiltration volume reduction.
(4) Age: Compared to normal adult weight accounted for the proportion of body fluids (male 60%, female 55%), the elderly fluid volume accounted for only 45% of body weight, elderly fluid volume decrease was mainly cellular dehydration retreat , reduce the intracellular fluid, extracellular fluid relative increase in non-dominant edema easy to state. Therefore, elderly dialysis patients are more likely in non-dominant edema state, and sometimes rely solely on clinical symptoms and signs to determine its capacity state are inaccurate and need to rely on physical examination.
2 How to assess edema
(1) Clinical Assessment: Review history, to understand whether chest tightness, suffocation, whether new or existing cardiovascular disease aggravated, if not tolerate dialysis prescription now, with or without salt intake increases, with or without decreased urine output and so on. Blood pressure is a reflection of the importance of the body volume load status symbol, especially when limiting water and salt intake and increased peritoneal ultrafiltration, the blood pressure failed to return to normal, then better able to explain the existence of the load capacity.
(2) laboratory tests: the conduct of clinical assessment can also carry out some laboratory tests to help determine the cause edema, such as B-type natriuretic peptide (BNP), echocardiography, bioelectrical impedance analysis (BIA) and so on. But these are not the assessment of the state of the gold standard in vivo capacity, so they need doctors combine comprehensive assessment of the patient's condition.
3 peritoneal dialysis patients how to avoid edema
(A) record daily volume of urine and ultrafiltration, periodically check the load capacity of relevant indicators, based on urine output restrictions on drinking water.
(2) periodic assessment of peritoneal function (PET), according to the type of peritoneal transport, timely adjustment of dialysis prescriptions, maintain the appropriate amount of peritoneal ultrafiltration.
(3) have occurred in patients with edema, should actively look for reasons to strengthen restrictions salt intake. For patients with residual renal function may be used under the guidance of doctors diuretics, as appropriate, the use of high concentrations of glucose dialysis solution, if necessary, diverted automated peritoneal dialysis. Diabetic patients should strictly control blood sugar.
(4) attention to the protection of residual renal function, avoiding the use of nephrotoxic drugs, to avoid dehydration.
(5) prevention of peritonitis occurred in strict accordance with the operating rules for fluid.
4 limiting salt intake method
(A) control salt intake: Excessive salt should lead to water retention. Daily salt intake should be <3 g, avoid foods high in salt, such as pickles, soy sauce, avoid the use of chicken, MSG and other spices with high salt, low sodium can be used when cooking can add more flavoring agents, such as green pepper, chili, pepper, pepper, lemon, onion, ginger, garlic, onions, etc., to increase the taste of food.
(2) control of water intake: try to eat with high moisture, low nutritional value foods such as soup, porridge, etc., preferably in milk, soup and other nutritious foods instead of water, tea, although may be liquid meals to medication; may be allowed to drink water every day with a fixed glass bloom and fractionated drinking, and small mouth slowly swallow, do not gulp, both for the control of water can accurately Record the total daily water intake. In addition, the water temperature to cool side appropriate to avoid overheating, in order to achieve the purpose of thirst, we recommend gargling with cold water containing ice (especially lemonade made of ice), but do not swallow. Regular brushing, toothpaste, toothbrushes in the refrigerator, with sour foods, chewing gum can keep your mouth moist.
(3) do intake and output records, especially snacks, soup, fruit, infusion volume and water intake, etc., including the amount of dialysis ultrafiltration volume, urine, vomit and a daily volume of about 500 ~ 700mL not dominant negative water (change with the seasons), keeping the total daily intake and the amount roughly equal.

Can dialysis cure kidney disease patients

Q: Can dialysis cure kidney disease patients?
A: Dialysis is not a cure for kidney disease. When kidney disease progresses into advanced stages, kidneys are severely impaired and overall complications will occur. Anemia, vomiting, weakness, high potassium, cardiovascular diseases.. ..just to name a few.
Dialysis as an artificial filter can remove toxins so as to relieve complications. However, it can not improve the kidneys at all. Kidney function declines continuously during dialysis. Some short term and long-term complications can occur. Patients on maintenance dialysis may find themselves make less and less urine.
The advice for patients on borderline of dialysis is that, your kidneys can be improved and there are great chances of avoiding dialysis if proper treatment is adopted. On the one hand, control complications positively; on the other hand, treatment of the kidneys is much more essential. Combination of the two aspects is the most ergent thing for you.