Uremia two diagnostic criteria in clinical practice, a fourth of the chronic
renal insufficiency, chronic renal insufficiency based on the level of serum
creatinine in China is divided into four: a renal decompensation, serum
creatinine 133-177 (Scr) umol / L; two renal decompensation, serum creatinine
(Scr) 177 443umol / L; three renal failure of (uremia early), serum creatinine
(Scr) and 443-707umol / L; four uremia, serum creatinine (Scr)> 707umoll / L,
respectively. Another is chronic kidney disease (CKD) Stage V chronic kidney
disease (CKD) is a foreign based on glomerular filtration rate (GFR) is divided
into five: 1 and GFR> 90ml/min/1.73m2; period, GFR, 60-89ml/min/1.73m2; 3,
GFR, 30-59ml/min/1.73m2; phase, GFR, 15-29ml/min/1.73m2; and GFR
<15ml/min/1.73m2 ( or dialysis).
Uremia, in fact, refers to almost all of fibrosis in kidney tissue, resulting
in loss of kidney function, not the human body through the kidneys produce
urine, and waste generated by the in vivo metabolism and excessive moisture can
not be eliminated from the body, such as glucose, proteins, organic acids ,
sodium, potassium, sodium bicarbonate, acid-base balance disorders resulting in
disorders of the human environment, as well as the endocrine function of kidney
abnormalities such as: the secretion of renin, erythropoietin, active vitamin
D3, prostaglandin exception. Modern medicine believe that uremia is a complex
syndrome of loss of renal function, the body's internal biochemical processes
generated by the disorder. Not an independent disease, known as renal failure
syndrome, or referred to renal failure.
Uremic kidney failure as the disease progress metabolic disorders caused by
the poison of the results. Uremia is not terrible, terrible complications of
uremia, in particular, to uremia advanced, involving the heart, lungs, liver,
spleen and other organs and systems, and each type of complications are
life-threatening, so it should be from the early high degree of attention.
From the Western point of view, clinical serum creatinine (Scr)> 707, will
be carried out hemodialysis, but the serum creatinine level is not the only
indicator of hemodialysis. In conjunction with the general vital signs of
patients with uremia, symptoms, clinical manifestations, and supporting test
results to assess the condition, does require dialysis must be timely or urgent
dialysis.
Dialysis is the artificial kidney - dialysis membrane and dialysis machines
to remove kidney failure when the patient's body more water, toxins, to correct
electrolyte and acid-base disorders. Dialysis membrane to separate the blood and
dialysate cleared from the serum by the principle of diffusion and convection of
water and toxins from the dialysate to supplement the lack of substance, such as
alkaline ions and calcium ions. In general, the purpose of dialysis is to
quickly bring down the body of water and toxins, alleviate the symptoms of
uremic patients, prevention of complications.
Uremic patients due to the role of renal hypertension, acidosis,
hyperkalemia, sodium and water retention, anemia, and toxic substances such as
heart failure, arrhythmias and myocardial damage. Stimulate the role of urea
(and possibly acid) can also occur aseptic pericarditis in patients with heart
chest pain, smell and pericardial friction rub on physical examination. Severe
pericardial cavity, cellulose and bloody exudate appears.
Dialysis is the most direct way to a rapid elimination of toxins from the
body, the body produces a lot of toxins to life-threatening, immediately clear
toxins, meet the basic environmental balance in the body, so that life can be
maintained, and also bring to the next treatment time.
Another point to emphasize is not the law of dialysis can solve all problems,
the control diet, drinking, smoking, alcohol, and to develop good habits,
improve immunity.
In general, the weekly dialysis patients, a daily water intake The lOOml and
24 hours of urine output and anuria in patients with daily water intake does not
exceed lOOml; patients with dialysis two times a week, daily water intake plus
for 300ml 24h urine output and water intake in patients with anuria not more
than 300ml; dialysis three times a week, daily water intake for the 500ml plus
the amount of urine, the daily water intake in patients with anuria not more
than 500ml. Water intake must be limited, otherwise it will result in edema;
complications such as hypertension and heart failure. In hemodialysis patients
into the water every day how much is good, should be based on the patient's
specific circumstances. In principle, Expenditure and Revenues to maintain a
balance. The amount of urine, vomiting and diarrhea volume, dominant negative
water (400-600ral/24h the) and dialysis dehydration.
Intake including daily water intake, the sum of the water content in food and
in vivo metabolism of endogenous water. Determine the water in the body fluid
balance is the most simple method is to measure weight, dialysis patients should
be weighed in a day, requiring dialysis during the weight increases in the l
less than 1.5kg a short period of time the weight changes are result of changes
in liquid water in the body. Dialysis patients can not rely on increasing the
ultrafiltration to improve the day-to-day into the water, because of the large
number of rapid ultrafiltration hemodialysis water will cause the drop in blood
pressure, cramps, headaches and other symptoms, and chronic water overload to
increase cardiovascular load. The consequences are bad.
As for the management of salt, usually avoid high salt foods such as salted
fish, salted egg, bacon, pickles, sauce and a variety of pickled products,
oliguria, edema, blood pressure, should be controlled salt intake intake, on
behalf of the salt is not abuse. Patients with dialysis three times a week, the
daily salt intake of about 4g weekly dialysis patients daily salt intake of
3g.
Therefore, the high toxins in the body of uremic patients to stimulate
cholestasis is extremely dangerous to life, we must implement the dialysis
quickly to eliminate toxins from the body, meet the basic environmental balance
in the body, so that life can be maintained.