Can Conservative Treatments Help Kidney Failure Avoid DialysisThis article was provided by doctor zhengfalei 2019-04-18 10:16
Most uremic patients in China have to undergo dialysis treatment to continue their lives, and very few people have the opportunity to have kidney transplants.
Do Uremia Need Dialysis?
If it was before the 1950s, the answer was no, there was no dialysis technology at that time. For more than half a century, dialysis has been the mainstay of life for uremic patients. Uremia is almost equal to life-long dialysis.
However, with the progress of medicine and the improvement of patients'economic and health literacy, the control of complications in patients with renal failure is getting better and better. In recent years, we have found that when the glomerular filtration rate drops to 15 ml/min, that is to say, when entering the uremic stage, many patients can be maintained by medication (conservative treatment), avoiding obvious complications, thus maintaining a normal life without dialysis for a long time.
Which uremic patients can not dialysis, conservative treatment?
1. Stable condition or slow progress
2. The complications were not obvious.
3. Occasionally need help
Under conservative treatment, the glomerular filtration rate (GFR) of uremic patients with these three characteristics, especially the younger patients with better physique, usually decreases from 15 ml/min to 10 ml/min after several years without dialysis. We will communicate with them, during which we will pay attention to whether the patients have family support, whether they can maintain a good mood and a reasonable diet. If the patients want conservative treatment, we will establish a medical care plan in advance.
However, patients with rapid progression, bed rest for most of the time and more complications are usually not recommended for conservative treatment, but for dialysis as soon as possible. This part of uremia patients often have poor primary diseases, such as lupus, anka-related nephropathy, membranous proliferative nephropathy, crescent nephritis, etc.
Key points of conservative treatment
1. Control blood pressure, because many antihypertensive drugs can lead to glomerular filtration rate decline, dyspnea, systemic peripheral edema, so blood pressure does not have to fall to normal, can be relaxed to 160/90 mmHg.
2. Limit salt and sodium in diet to avoid capacity overload.
3. Correct anemia, use erythropoietic stimulants and iron to improve symptoms of fatigue and dyspnea. Blood was examined once every 3 months for anemia.
4. Improving acidosis can alleviate fatigue, bone loss, muscle atrophy and malnutrition. It is suggested to take sodium bicarbonate orally and check the carbon dioxide binding force once in March to judge the acidosis condition.
5. Regulating the balance of calcium and phosphorus, abnormal metabolism of calcium and phosphorus can lead to myalgia, arthralgia, pseudogout and restless legs. It is necessary to limit the intake of phosphorus, use phosphorus binder to reduce phosphorus, and check the level of calcium and phosphorus every three months.
6. Supplementation of low-dose active vitamin D can improve the symptoms of fatigue, weakness and muscle loss.
7. Maintain normal blood potassium. There is a need to limit the potassium diet and use potassium-bound resins. If life-threatening hyperkalemia occurs, sodium polystyrene sulfonate can be used. Blood potassium was tested once a month.
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