Hello everyone, I am a nephrologist. When it comes to high blood pressure, I think many people should understand that it is the most common and frequent chronic disease in my country. The factors that cause high blood pressure are different. Today I focus on introducing “renal hypertension”. Let’s be straightforward, that is to say, the increase in patients’ blood pressure is inseparable from “kidney problems”. Such patients often have very difficult blood pressure control, and may need to combine three or even four or more antihypertensive drugs to Regulate blood pressure. Why is blood pressure in patients with kidney disease so difficult to control? How to effectively solve this problem? Today I am going to do a popular science explanation for everyone on “renal hypertension”. Foreword ● Hypertension is a common complication of chronic kidney disease. There are epidemiological data showing that 80%-85% of patients will develop hypertension during the progression of chronic kidney disease. And as the glomerular filtration rate decreases linearly increases (that is, the worse the renal function, the greater the proportion of people with hypertension). There was a special scientific research team to investigate and follow up on this. One report from the MDPD showed that when the glomerular filtration rate dropped from 85ml/(min.1.73㎡) to 15ml/(min.1.73㎡) The prevalence of hypertension increased from 65% to 95%. ● I found a phenomenon, some people have this idea, thinking that my blood pressure is high, but I do not have headaches and dizziness, eating the smell of sleeping, the high point will be high, and it will not hinder me. Too much hurt the body. Note that hypertension is not only one of the important risk factors that cause the progression of chronic kidney disease, but also the risk factors for cardiovascular and cerebrovascular complications in patients with chronic kidney disease (such as myocardial infarction, coronary heart disease, cerebral infarction, cerebral hemorrhage, etc.). According to incomplete statistics, the current control rate of renal parenchymal hypertension in my country is 46% (140/90mmhg) and 20% (130/80mmhg). It can be seen that effective blood pressure prevention and control is still a long way to go. Causal analysis of hypertension and kidney damage ● Here I tell you that under normal circumstances, our kidneys have their own regulatory mechanisms. That is, the glomerular internal pressure and the average arterial pressure are in an “S” shape, that is, in the range of average blood pressure of 80-160mmhg, it regulates the contraction and relaxation of the small arterioles by the intrinsic muscle (this small artery constitutes the kidney Important blood vessels), so that the glomerular blood flow and glomerular filtration rate can be maintained stable. ●But when you suffer from chronic kidney disease, this self-regulating mechanism will be damaged, and this “S”-type regulating mechanism will slowly turn into a nearly “linear” type. Therefore, in patients with chronic kidney disease, even if the system blood pressure is slightly moderately increased, it can cause the internal pressure of the glomeruli to increase, resulting in the three high states of high pressure, high perfusion and high filtration in the glomeruli. And this “three highs” will cause progressive kidney damage. The common understanding is that “hypertension” and “kidney damage” will always hurt each other, causing the disease to progress in a bad direction. ●Compared with essential hypertension (more than 90% are clinically essential hypertension), this kind of renal hypertension will show such characteristics: ① blood pressure is difficult to control, and it is easy to develop into malignant hypertension, It is often necessary to combine several antihypertensive drugs, and the blood pressure compliance rate is still low. ②The incidence of cardiovascular complications is high, and its impact on cardiovascular disease has its own characteristics. A scientific research team has conducted a follow-up study of more than 20,000 community population. The results show that the relationship between hypertension and stroke in patients with chronic kidney disease is ” “J-shaped”, the systolic blood pressure is the lowest at 120-129mmhg, while the incidence of stroke below 120mmhg and above 130mmhg is significantly increased. How to effectively regulate renal hypertension? ●Pharmacological treatment ① For patients with chronic kidney disease, if proteinuria <1g/d, then blood pressure is recommended to be controlled at 130/80mmhg; if proteinuria>1g/d, then blood pressure is recommended to be controlled below 125/75mmhg. However, I personally think that blood pressure is not lower, the more beneficial it is, and everything is about one degree, because too low blood pressure will affect the blood perfusion of the kidney. Hypoperfusion is not a good thing for the kidney, so it is recommended to avoid low systolic blood pressure. At 110 mmhg, the diastolic blood pressure is below 60 mmhg. ②It is found in the clinic that in fact, many elderly people not only suffer from hypertension, but some people also have diabetes and other chronic diseases.
Beer is a very popular drink for men, especially when the weather is hot for supper or friends gathering, they will drink a few glasses. However, drinking too much beer is harmful to the body. Especially for people with kidney disease, how to drink beer will increase the burden on the kidneys, and it may lead to kidney failure. Drinking too much beer leads you to kidney failure. Beer contains alcohol. Alcohol will increase the burden on the kidneys during the metabolic process. At the same time, the hops in beer have a diuretic effect and also increase the burden on the kidneys. At the same time, the liver will also be injured. After the liver is injured, the toxic substances cannot be used, which further increases the burden on the kidney. If you already have kidney disease, and often drink a lot of beer, it will cause uric acid deposition and block the renal tubules, causing kidney failure. Symptoms of early renal failure: Symptom 1: The cardiovascular system usually has symptoms of high blood pressure or heart failure, and often feels palpitations or wheezing. It is often impossible to lie down flat, and the heart rhythm is also prone to arrhythmia. Pericardial effusions can also occur, and sometimes they can become clogged. Symptom 2: After the disease occurs in the nervous system, there will be insanity, headache, dizziness, and some patients will have a sudden drop in memory. Symptoms such as insomnia and dysuria are also often seen. Severe patients will also experience coma. . Symptom 3: Digestive system After the disease occurs, patients often feel anorexia, nausea, vomiting, diarrhea, etc., often feel the smell of urine in their mouth, or gastrointestinal bleeding. Symptom four: When the skin shows that the disease occurs, there will be scaling. The skin will often feel dull, and sometimes there will be pigmentation of the melanin, the skin color will appear darker, edema or skin infection And other undesirable phenomena. Symptom 5: Respiratory system When the disease occurs, it also affects our respiratory system. I often feel the smell of urine in my mouth, and there is also gas breathing from metabolic acidosis. . How to treat the primary disease and inducement treatment of chronic renal failure For the first diagnosis of CRF patients, we must actively pay attention to the diagnosis of primary disease. For chronic nephritis, lupus nephritis, purpuric nephritis, IgA nephropathy, diabetic nephropathy, etc. Maintain long-term treatment, at the same time, we should actively look for various inducing factors of CRF, and correct these incentives reasonably may reduce the lesion or tend to stabilize and improve renal function to a greater extent. Dietary Therapy Chronic renal failure dietary therapy has been regarded as its basic treatment for many years, and it has been respected by scholars from various countries. The previous diet therapy is generally limited to the application of low-protein diets, but long-term low-protein diets will affect the nutritional status of patients. Studies have shown that the incidence of chronic renal failure malnutrition is as high as 20% to 50%. Severe malnutrition is now considered to be independent of CRF The risk factors are directly related to the morbidity and mortality. Therefore, the current diet therapy is more inclined to formulate more reasonable nutrition treatment programs for patients. Alternative therapy includes hemodialysis, peritoneal dialysis, and kidney transplantation, which have the highest quality of life. When the blood creatinine is higher than 707μmol/L or GFR10ml/min (15ml/min in diabetic patients), and the patient begins to develop clinical manifestations of uremia that cannot be relieved by treatment, dialysis treatment should be performed. Prior to this, patients should be prepared for their thoughts in order to make decisions about hemodialysis, peritoneal dialysis, or kidney transplantation. Dialysis should usually be performed for a period before considering kidney transplantation. Dialysis therapy can replace the excretory function of the kidney, but not the endocrine and metabolic functions. Hemodialysis (referred to as hemodialysis) and peritoneal dialysis (referred to as peritoneal dialysis) have similar therapeutic effects, each has its own advantages and disadvantages, and can complement each other in clinical application. 1. Hemodialysis should be done in advance (several weeks before hemodialysis). Arteriovenous fistula (vascular access); dialysis time ≥ 12h per week, usually 3 times per week, 4 ~ 6h each time. Adhere to adequate and reasonable dialysis , Can effectively improve the quality of life of patients, many patients can survive for more than 20 years. 2. Peritoneal dialysis, continuous ambulatory peritoneal dialysis therapy (CAPD) has the same effect on hemodialysis as uremia. CAPD is especially suitable for patients with cardio-cerebrovascular comorbidities, diabetic patients, the elderly, pediatric patients or those with difficulty in performing arteriovenous fistula. CAPD is continuous
Hemodialysis is an alternative treatment to save lives after chronic renal failure enters the uremia stage. A reasonable and accurate diet can not only prevent or reduce the occurrence of complications, but also maintain a good nutritional state, thereby improving the quality of life and survival rate of patients. However, many kidney friends who are on dialysis do not know how to eat. Let me introduce you to “Dietary considerations during hemodialysis”. Let’s take a look. 01. Low-salt diet maintenance hemodialysis patients should be given a low-salt diet, salt intake should be controlled at 3-5g/d. Excessive salt intake, excessive sodium ions in the body are likely to cause increased blood pressure, edema, ascites, hydropneumonia, and heart failure. The sodium ions mainly come from the sodium salt in food. In addition to table salt, common high-salt foods include soy sauce, monosodium glutamate, ketchup, sand tea sauce, soda crackers, noodles, and preserved products. So, in daily life, how do we judge the salt content of food? The table below shows the table of salt content (6g) for common foods. Such as: 27g of lamb meat, the salt content is 6g. 02. Low potassium diet Hemodialysis kidney friends have inadequate kidney function and cannot effectively discharge excess potassium in the body. Too high blood potassium will cause severe cardiac conduction and contraction abnormalities, and even death. Hyperkalemia is the most serious complication of end-stage renal disease, so a low potassium diet should be used. While choosing low-potassium foods, you can also reduce the potassium content in foods by soaking, boiling, and ultra-low temperature refrigeration. Foods with high potassium content are mainly vegetables and fruits. Common high-potassium foods are garland chrysanthemum, potato, yam, spinach, amaranth, rape, banana, jujube, etc. 03. The main function of phosphorus in a low-phosphate diet is to strengthen bones, and excess phosphorus needs to be excreted through the kidneys. For hemodialysis friends, the kidneys cannot work properly, and excess phosphorus will accumulate in the blood, causing hyperphosphatemia, which can lead to skin itching, soft tissue calcification, renal bone disease, and secondary hyperparathyroidism, etc. . The Guidelines for Improving the Global Prognosis of Kidney Disease (KDIGO) guidelines suggest that a low-phosphorus diet is the first-line treatment for reducing blood phosphorus levels. Therefore, hemodialysis patients should choose low-phosphorus foods, the daily intake of phosphorus should be limited to 600 ~ 1000mg. Almost all foods contain phosphorus, and daily diets should avoid high-phosphorus foods such as egg yolks, whole wheat noodles, animal offal, dried beans, nuts, milk powder, chocolate, cola, and processed meat. 04. Long-term hemodialysis with a low-fat diet is often accompanied by disorders of fat metabolism. The intake of fat and cholesterol should be restricted to prevent aggravation of hyperlipidemia and arteriosclerosis. Fat intake accounts for less than 30% of daily calories (50-60g), mainly edible vegetable oils, such as corn oil, soybean oil, olive oil, etc. Avoid the intake of saturated fatty acids and trans fatty acids such as butter, shortening, lard (pork belly), and butter. 05. Appropriate protein diet Before dialysis, nephropathy needs a low-protein diet; after dialysis, protein loss will increase, and it is easy to cause malnutrition. Therefore, according to the frequency of dialysis to increase protein intake. Usually dialysis 1-2 times a week, daily protein intake per kg body weight is 1.0g; while dialysis 3 times a week, daily protein intake per kg body weight is 1.2g, and ensure that at least 60% of the protein is high-quality protein, Such as lean meat, fish, eggs, milk and soy products such as tofu or Qian Zhang.  . Hemodialysis is performed intermittently, and diet is directly related to the effect of dialysis treatment. Because it does not filter waste from the body like a kidney, it means that waste will accumulate in the blood during the dialysis interval. Therefore, we must establish the correct concept of dialysis diet!
Hello everyone, I am a nephrologist, concerned about lung health, nephrology is in action. Some friends may have questions. Isn’t uremia not a kidney problem? Does it have any bad influence on the “lung”? Indeed, it’s not that I’m here today, and we call it uremic lung edema. Although it sounds unfamiliar to me, the clinical incidence can reach 50%-80%. It is chronic Pulmonary complications in patients with renal failure progressing to the uremic stage. As the dialysis technology becomes more mature, the survival rate and survival time of uremic patients are greatly prolonged, so this complication is getting more and more attention. Today I will come to do a science explanation for everyone on “Uremic Lung Health”. Why does uremia cause lung disease? I think it can be explained in the clinic with monism, just like the heart-kidney syndrome and liver-kidney syndrome. ● From the heart: I believe friends who have read my popular science articles should be clear, I’m talking about uremia, Chronic renal failure will repeatedly emphasize the need to actively prevent complications such as renal hypertension, renal anemia, excessive capacity load, malnutrition, and toxin accumulation. Today I want to tell you that this is not groundless. All of the above factors may cause heart failure such as heart failure, pericarditis, myocarditis, cardiomyopathy, and calcification of the heart. These heart disease changes can increase the pressure of the left atrium of the heart, so that the capillary pressure of the lungs increases, and then there is pulmonary edema. In the long run, the compliance of the lungs decreases, and the pressure of the blood vessels and small airways of the lungs increases. Changes in lung function and structure. ●Explained from the blood: a number of studies have confirmed that after entering the stage 3 of chronic kidney disease (a total of 5 stages, the last stage is uremia), the human body will gradually begin to develop renal anemia, and the consequences of anemia are caused by The alveolar capillary blood flow is reduced, which affects the diffusion function of the lung. This is one of them; like malnutrition, hypoproteinemia (a complication of chronic renal failure) will make our body’s plasma colloid osmotic pressure drop, thus Causes pulmonary edema, which is the second; if it is a diabetic nephropathy patient, the high blood sugar state in the body will cause the crystal osmotic pressure of our human plasma to increase, causing body fluids to enter the blood vessels from the cells, resulting in further increase in blood pressure and cardiac output Blood volume drops, causing heart failure and pulmonary edema, which is the third. ● From the perspective of disease: uremic patients are prone to azotemia. In this case, it will lead to toxic hyperemia and increased permeability of pulmonary capillaries, causing a large amount of fluid in the pulmonary blood vessels to penetrate into the lung tissue, causing lung Lesions. Interpretation of common clinical manifestations of alveolar uremic lung ● The most common is cough and sputum, the incidence rate is greater than 50%, followed by dyspnea, the incidence rate is about 30%-50%. In particular, the shortness of breath will be more obvious when lying on the ground. The degree of severity varies, and some patients may also show “hemoptysis”, but most of them will be accompanied by unilateral or bilateral pleural effusion, which is the common pleural effusion. Too. Note that the nature of its effusion is mostly “slurry cellulose exudation”. ●In imaging, the most typical chest radiograph of the uremic lung is “butterfly wing-like or bat-like exudation of the bilateral lungs”, which means that it is centered on our hilum, forming a butterfly or Bat-like shadow, as shown below. We can roughly divide its imaging characteristics into 5 stages, namely alveolar pulmonary edema, pulmonary congestion, interstitial pulmonary edema, pulmonary interstitial fibrosis, and cardiac enlargement. Uremic lung, prominent ooze in the image, uremic lung, prominent uremic lung in the image, significant ooze in the image ●But from personal experience, clinically still with alveolar edema and heart The expansion period is more common, because these two types of heart failure will occur, but this is a significant difference from ordinary lung infection. If the dialysis and dehydration can be fully clinically, this butterfly or bat-like exudation can quickly disappear. Therefore, it is essential to ensure the sufficiency of dialysis and increase ultrafiltration, which is also the core treatment plan for this complication. How should uremic patients respond to the “lung” complication? This is the point I want to talk about. The above theory may sound a bit tedious, but I think I have to say it again, because only if the principle understands the doctor’s explanation and the adjusted treatment plan can you better cooperate, this can also Improve patient compliance. ●I believe that the experienced kidney friends should know that the uremic patients
On August 27, 2017 (Lunar Calendar), this day was originally a happy day, because this day is my birthday, but the facts are not there. On this day, I was medically identified as chronic suicide-uremia. On the day of the diagnosis, I felt that it collapsed in just a day. This birthday gift came too abruptly and could not be refused. I have since embarked on the path of dialysis. I used to work on site at the construction site, and the work was heavy and tiring. Since I became ill, I could only retreat to the second line and go to the office to do some relaxing work. The company has staff quarters, but in order to have a better dialysis environment In order to avoid infection, I rented a house next to the construction site and returned to rent a house to change my water after eating. Both work and life were correct. During the dialysis time of nearly 3 years, my small problem was constant, but the big problem never happened. I immediately consulted the doctor and the doctor adjusted the medication, and it took 3 years. With the support of family, relatives and friends this year, I am going to have a kidney transplant. At the beginning of the year, I went to major hospitals to line up for matching. Maybe the goddess of fortune saw me pitiful, and gave me good luck. I queued for a month and received The hospital’s phone said that the matching was successful and the transplant operation was possible. Upon hearing this news, I was so excited that I couldn’t speak. I thank my family and relatives and friends for giving me a chance to be reborn. On the day of the operation, I was nervous and excited. I was nervous because it was a major operation or there was a certain risk. I was excited because my quality of life would improve a lot after the transplant. On August 13, 2019, on this day, I successfully completed the transplant operation. The operation was very successful, and the recovery was very good after the operation. There were no adverse reactions. In order to facilitate the postoperative examination, the family rented a house around the hospital and let me live when I was discharged. I have just been discharged from the hospital and now I feel that everything is in good physical condition. The six months after transplantation is a very special period. I must listen carefully. Doctor, protect my kidney baby, because this is my rebirth! Since the transplantation has just finished, the living environment should be ventilated and the air is good. Try not to go to a densely populated place. You must wear a mask when you go out. So after transplantation, I have been resting at home, not working, and it takes about six months to a year of rest. Life starts again from now on, and hopes that the future will get better and better.
I have 27 eye dialysis for 3 years! Looking back now, it should be around the time of urination around 2013, but the feeling of not urinating but having to wait for a while! There is always feeling that the eyes are hot and swollen! It feels good to apply something Bingbing to your eyes! At that time, myopia was always thought to be caused by excessive use of eyes. Bought a lot of eye drops! After myopia, the eyes will become more and more outward, and the eyes will become smaller and smaller, always listless! Nothing to do with anything! Feeling boring! The 27-year-old girl has been on dialysis for three years, recalling the past and regretting it, but there is no problem with the physical examination for the college entrance examination. I don’t know if it is not checked or what is going on? It should not be checked. After all, this thing is relatively hidden. There is no sweating! If you sweat, only your face sweats more! The hair on the body seems to be in the skin! In short, don’t sweat! Does not sweat even the feet! Feeling stinky in junior high school and then no longer stinking because no sweating! Sweating is also sweating on the head and sweating on the face! After going to college, I feel that I have entered the second stage, thirsty and super thirsty! Drinking water must drink super-hot water or ice-cold drinks with super-cold water! You can’t drink ordinary water! Warm water is disgusting! You must drink that super hot and cold water! Warm water must be added before drinking! ! But after drinking it, I feel very thirsty after a while! (this feature is obvious to me) I have more nocturia! A lot of urine! Excessive urine at one time! The color of urine is the same as water! Sprite bottles with 2l of urine can hold more than half in one night! I have been sick since childhood. The 27-year-old girl has been on dialysis for three years, recalling the past, regretting that his face has not been so good, without ruddy! Even his face turned yellow, but he didn’t care! It is especially easy to get angry during this period! I hurt the corner of my mouth as soon as I get angry! There is also a sore throat! Drink again when your throat is uncomfortable again. It is also particularly easy to catch a cold. Another year after going to the toilet, I pee a lot! And there are many bubbles! Like washing powder! The strange smell in the mouth always feels bitter in the mouth! Always want to eat some sugar or something (in fact, this time is the urine drains from the body without detoxifying the urea smell in the mouth) In fact, this time is basically approaching the late stage. And when you sleep, your legs and arms will shake unconsciously! After another year, the thirst became more difficult to control, and I was thirsty again after drinking water for half an hour! In the middle of the night, I often wake up with a sore throat and then drink some water to continue to sleep. There is not much change in the rest! Another thing is that his hands are yellow and no blood color (kidney problems caused anemia, look at the hands and blood color is basically determined) The first half of the onset is particularly easy to stomp! Running doesn’t know what’s going on Two months before the onset: It was easy to be frightened. He had clearly seen the person, but he suddenly shuddered when he spoke. The 27-year-old girl has been on dialysis for three years. Recalling the past, regretting it is easy to be surprised! Memory decline! One week before the onset, physical strength decreased significantly! Face is even worse! Reduced urine output. From time to time, I feel dizzy (high blood pressure caused by the kidneys) and get a cold again a few days before admission! Sleeping leg cramps at night! Frequent cramps (in fact, this is caused by too high toxins) and then the urine volume is reduced. Lie down and breathless! Can’t breathe to go to the hospital and then directly hospitalized for direct dialysis. Personal advice is to check your hands from time to time. Many people find that their hands are actually white at the end, without any blood. In fact, this is the most obvious change in anemia! Face is really important! Kidney is mainly detoxification and drainage! Blood test There is a creatinine value check in the blood draw! This is a good standard for checking kidney function! As long as it exceeds the standard, there is basically a problem! The average healthy person is less than 100, and my tolerant ability is not the same for each of my 1800 onset! Some people may be uncomfortable for hundreds of meals and so on! Loss of appetite is also a manifestation! If you don’t want to eat anything, you want to drink. Some people will have swollen legs and swollen faces, everyone is different! However, there are basically problems with leg swelling, and I am not swollen from beginning to end! Don’t force yourself in! The key is to see if you can’t get up to anything! I don’t smell anything, I just feel thirsty, I drink ice water and drink non-stop! The palms turned yellow and the eyes were swollen! Pee foam! If it is best to check more! Kidney disease is a silent killer, it does not hurt or itchy, so when you have been feeling unable to lift your energy, it is best to go to the hospital
Uremic disease is not the name of a disease. Uremic disease is a group of syndromes in which various kidney diseases progress to the terminal stage. Simply put chronic renal failure to the end stage is what everyone says is uremia. If it is only a problem of kidney failure itself, long-term dialysis can replace the kidney, it can also survive for a long time, but when it progresses to the uremic stage, not only will kidney problems occur, but various systemic diseases will appear in the body, which is a group of syndromes that will eventually cause disease Heavier and died. First, the cause of uremia is the end stage of chronic renal failure is uremia, then the cause of chronic renal failure is the cause of uremia, the main causes are primary glomerulonephritis, chronic pyelonephritis, hypertensive renal arteriosclerosis, Diabetic nephropathy, secondary glomerulonephritis, tubulointerstitial disease, inherited kidney disease, drug poisoning, etc. Second, the classification of chronic renal failure The traditional classification of chronic renal failure, the fourth stage, which is the end stage, which is the uremic stage. When the glomerular filtration rate in the compensated renal function period is 1/2, the blood urea nitrogen and creatinine do not increase, the metabolic balance in the body does not appear, and no symptoms appear. The blood creatinine is between 133 and 177 μmol/L. The glomerular filtration rate in the renal insufficiency stage is below 50% of the normal value, and the blood creatinine level rises above 177 μmol/L. It may have symptoms such as fatigue, loss of appetite, nocturia and mild anemia. During renal failure, the creatinine clearance rate drops below 20ml/min, creatinine rises above 442μmol/L, anemia occurs, blood phosphorus level rises, blood calcium decreases, metabolic acidosis, water and electrolyte disorders, etc. The end-stage creatinine clearance rate of uremia is below 10ml/min, creatinine rises above 707μmol/L, acidosis is obvious, and various system symptoms appear, resulting in coma. Of course, according to the glomerular filtration rate, the American Kidney Disease Foundation now divides chronic renal failure into five stages: stage 1: glomerular filtration rate stage 902: glomerular filtration rate stage 60-893: glomerular filtration rate Ball filtration rate 30-594: glomerular filtration rate 15-295 stage: glomerular filtration rate <15 Most of the current use of this stage. 3. Symptoms of uremia Because uremia is a group of syndromes, it may affect many organs, so many symptoms will also appear. Systemic conditions: loss of appetite, vomiting, weakness, deep breathing, edema, ascites, pleural effusion, fatigue, anorexia, inattention, decreased body temperature, bleeding tendency, etc.; cardiovascular complicated with hypertension, angina pectoris, myocardial infarction, heart failure, Arrhythmia, etc.; Pulmonary edema of the respiratory tract or pleural effusion, pleurisy; Anorexia of the digestive tract, nausea, vomiting, or diarrhea; Light blood pressure system, moderate anemia, with bleeding tendency, such as subcutaneous or mucosal bleeding points, ecchymosis, gastrointestinal bleeding , Cerebral hemorrhage, etc. Nervous system reaction is indifferent, delirium, convulsions, hallucinations, coma, mental abnormalities, muscle tremors, spasms, nausea, vomiting, headache, convulsions; bone salt dissolution of the skeletal system, rib fractures, osteoporosis, etc. Fourth, how to treat uremia. Urinary replacement therapy is needed during the uremic phase, which is called dialysis. Many people with renal insufficiency have reached the dialysis stage and are reluctant to undergo dialysis, worrying about the side effects of dialysis; when the uremic stage, the kidneys should be damaged by more than 90%, if you have been procrastinating without taking dialysis treatment, then Toxins remain in the body and cause irreversible damage to the organs of the body to varying degrees, such as the heart, digestive system, bones, blood system, etc. Uremic disease is a disease that cannot be cured by medical treatment, and delay can only lead to aggravation of the disease. Therefore, patients with uremia have reached the stage of dialysis, and dialysis treatment as soon as possible. Statistics show that the average survival time of patients is about 5-8 years. Of course, there are not a few patients who have survived clinically for more than 10-20 years. Kidney transplantation is the most reasonable and effective treatment method for uremic patients, but due to the lack of donors, kidney transplantation cannot play its due therapeutic role. There are only more than 5000 cases of kidney transplantation in the country every year, and about every 150 waiting patients, only 1 person may get the chance of kidney transplantation... . .
During hemodialysis, about 20% to 35% of patients will experience muscle spasm symptoms-mainly manifested by sudden tonic contraction of muscles, and the pain will be more intense, which lasts for seconds or even minutes. If timely and effective intervention is not available, the patient’s compliance with hemodialysis will decrease significantly. 1. The main manifestations of muscle spasm are gastrocnemius muscle, intercostal muscles, cremaster muscles, back muscles, abdominal muscles, upper and lower extremity muscle groups, and hand muscles. Multiple attacks with lower limb muscles. 2. Measures to prevent and treat muscle spasms 1. Emergency treatment: keep warm and massage the spasms. Targeted treatment measures according to the reason: slow blood flow, suspend ultrafiltration, rapid intravenous infusion of saline, oxygen inhalation, intravenous calcium gluconate injection, etc. If the symptoms do not improve, the treatment can be ended. 2. Psychological dredge: When patients suffer from muscle spasms, they are prone to anxiety and nervousness. Talk to the patient to do a good job of comforting, distract their attention, and reduce tension. Pay attention to observe the puncture of the lateral limb of the internal fistula to avoid bleeding from the puncture point due to the patient’s pain and intolerance when sitting up or moving the limb and pulling the tube. 3. Correctly assess the patient’s dry weight: ① Comprehensively assess the patient’s water load before each treatment. ②Patients without obvious water and sodium retention and muscle cramps should adjust dry weight in time. ③Guide the patient to master the weight measurement method, fix the weight scale, and fix the clothes to measure, to avoid excessive ultrafiltration due to clothing changes, eating and other factors, and calculate the ultrafiltration correctly. ④Each ultrafiltration volume should be less than 5% of dry weight. Avoid muscle spasm caused by excessive ultrafiltration. 4. Individualized dialysis plan: adjust the dialysis plan and adopt individualized dialysis. Such as sequential dialysis, sodium curve dialysis, ultrafiltration curve dialysis; use a dialyzer with good biocompatibility; increase the frequency of dialysis. 5. Observation and care during dialysis: Observe patients closely during dialysis, and should pay more attention to patients with a history of muscle spasm. During dialysis, such patients should be visited more often, asking if there is any discomfort, closely observing changes in vital signs, and increasing the number of blood pressure measurements if necessary.
Hello everyone, I am a nephrologist. My daily job is to solve problems related to various types of kidney disease. Uremia is a major disease in the Department of Nephrology, so I am still familiar with the diagnosis and treatment of uremia Yes, I believe that many people have such doubts. Renal transplantation cannot guarantee 100% success in uremia. Even if the transplantation is successful, it can’t be managed for a lifetime. It still costs so much. Why are there so many people? Choose to transplant? Let me talk about my views below. Introduction to the treatment of uremia ● When it comes to the disease of uremia, I believe that many people are not unfamiliar, because there are many people who liken it to “undead cancer”. To put it plainly, uremia refers to the kidney The function has been completely lost, but life is active, and we must constantly eat and drink Lhasa. It is really not possible for the body’s metabolism to lack a kidney, so if you want to continue to live, uremia patients must choose renal replacement therapy. In today’s world, there is nothing more than three types: kidney transplantation, hemodialysis, and peritoneal dialysis. ● My Q&A and articles on hemodialysis and peritoneal dialysis have been introduced in detail many times. Here I want to tell you that compared with these three alternatives, kidney transplantation is the best alternative, which is also It is recognized by the industry, but the gap between ideal and reality is always so large, because of the cost problem, the problem of kidney source (about the situation of kidney source in China, I once wrote in my original article “The Road to Organ Transplant: Since 15 years, the death row has been officially suspended. Organ is one of the major changes in society”, which is explained in detail, and interested parties can click to read), so kidney transplantation can only be a treatment method for a small number of uremic patients, and more people can only choose hemodialysis helplessly Or peritoneal dialysis. Data introduction of survival rate after successful kidney transplantation ● Everyone needs to understand a concept. Successful kidney transplantation does not mean that there is no problem after transplantation and can manage for a lifetime. This way of understanding is wrong. In the industry, there are no problems three years after transplantation. , We can say that you have successfully transplanted. With the development of science and technology, the advancement of medical technology, the improvement of surgical techniques, the application of tissue matching, the improvement of related immunosuppressive drugs, the advancement of organ preservation technology, the survival rate of kidney transplantation is increasing, and in terms of transplantation, The level of transplantation in China has reached the forefront of the world. ●The author consulted the relevant data. According to the report of the United Organ Sharing Network, as of the end of 2008, a total of 84,318 kidney transplants have been performed in 521 transplant centers around the world. The longest survival record is 44 years of kidney transplantation from living relatives and kidneys from cadavers. After 37 years of transplantation, according to the relevant follow-up survey published in China, 3 cases of cadaveric kidney transplantation have survived for more than 31 years. The current 1-year survival rate of kidney transplantation is more than 90%, the survival period of cadaveric kidney transplantation hemisphere is 10.9 years, and the living kidney transplantation hemisphere The survival period is 17.9 years, so as the subject said, it is indeed rare to be able to manage for a lifetime, but I think that different kidney replacement treatments, kidney transplantation are significantly better than hemodialysis and peritoneal dialysis. Kidney transplantation rarely manages for a lifetime, why are there so many people transplanted? Indeed, after kidney transplantation, the survival rate of the transplanted kidney may not be managed for a lifetime, and eventually dialysis may still be required, but I can understand the pros and cons of these three alternative methods. ●Hemodialysis ① This is currently the most commonly used dialysis method. According to a large number of research comparisons, a uremic patient must reach more than 12 hours of dialysis time per week to ensure a certain dialysis sufficiency, so the patient must be on Wednesday After four hours of dialysis each time, and going back and forth to the hospital for such a long time, I may ask, one month and two months may feel okay, one year and two years, ten years and twenty years, the time is longer, if the anxiety is pessimistic, it may be Think, what’s the point of this? Living is for dialysis, dialysis is for life, let alone the quality of life decline, not many accompany you, and not many friends, loneliness will always be with you. ② Secondly, dialysis is not a panacea, there will still be complications such as renal anemia, renal bone disease, low calcium and high phosphorus, osteoporosis, renal hypertension, secondary hyperparathyroidism, etc. With the extension of dialysis time, more and more food will be taken. People who have not experienced it may be difficult to experience it, but those who have experienced it will definitely be able to feel that they will feel sick and disgusted when they take medicine for many years. Physically
Residual renal function (RRF) refers to the filtration and endocrine function of residual renal tissue after impaired renal function. For uremia nephropathy, kidney function is almost lost, why should we insist on protecting the “one-time” residual kidney function? The importance of residual renal function for dialysis Protecting the residual renal function of patients with chronic kidney disease is the primary task of treating kidney disease, and kidney friends undergoing dialysis are no exception. 01RRF affects survival rate. Residual renal function has an important relationship with the survival rate of dialysis patients. The loss of RRF is a high-risk predictor of peritoneal dialysis death. Studies have shown that peritoneal dialysis patients without residual renal function have more metabolic disorders, cardiovascular disease, severe anaemia of erythropoietin resistance, hyperphosphatemia, hypocalcemia, and more than patients with residual renal function Infection and severe malnutrition. 02RRF can remove intermediate molecular toxins. Residual renal function plays an important role in removing intermediate molecular toxins. Studies have shown that high peritoneal dialysis can promote the removal of water-soluble small molecules in patients with residual renal dysfunction, but it cannot increase the removal of medium molecules and other protein-bound uremic toxins. 03RRF and inflammation dialysis patients have a high incidence of inflammation (12%-65%). The study found that the incidence of inflammation in patients with peritoneal dialysis is closely related to residual renal function. Studies of chronic kidney disease before dialysis have also shown a correlation between the two. How to protect residual renal function 01 dialysis compared with hemodialysis, peritoneal dialysis has obvious advantages in protecting residual renal function. Clinical observations confirmed that although the residual renal function showed a downward trend after hemodialysis and peritoneal dialysis treatment, the rate of decrease of residual renal function in hemodialysis patients was more than twice that of peritoneal dialysis patients. 02 Avoid drug abuse Avoid using drugs that are toxic to the kidneys to protect residual renal function. Angiotensin-converting enzyme inhibitors, non-steroidal anti-inflammatory drugs, aminoglycosides, anti-radiation agents, etc. that impair residual renal function. In addition, improper use of nephrotoxic drugs, such as gentamicin, kanamycin, tobramycin, vancomycin, and amphotericin B, can also aggravate renal tissue damage when treating infections. 03 Controlling blood pressure Maintaining good blood pressure is beneficial to protect the residual renal function of dialysis patients. Hypertension and higher diastolic blood pressure are related factors for the rapid decline of residual renal function. When the systemic blood pressure increases, the high blood flow and high perfusion status of the remaining nephrons can be further aggravated, the small arteries in the kidney, the hypertrophy of the wall, and the narrowing of the lumen will cause ischemic lesions of the remaining nephrons. Although the residual renal function is very small, it is effective in removing toxins and excess water. In addition, clinical experience also tells us that in the face of different dialysis patients, patients with partial urine output after dialysis have higher survival status and quality of life than patients without urine. Therefore, it is particularly important to protect the residual kidney function!
Creatinine is a product of muscle metabolism in the human body, and every 20g of muscle metabolism can produce 1mg of creatinine. Creatinine is mainly excreted by glomerular filtration. Blood creatinine comes from exogenous and endogenous sources. Exogenous creatinine is the product of meat food after metabolism in the body; endogenous creatinine is the product of muscle tissue metabolism in the body. When the intake of meat food is stable, there is no big change in the body’s muscle metabolism, and the production of creatinine will be relatively constant. Creatinine is the most important indicator of kidney function in patients with nephropathy! Creatinine is also a benchmark for uremia judgment! The average patient thinks that creatinine exceeds 707umoI / L, which means that uremia should be dialyzed for life. The standard habit of hemodialysis treatment for clinical uremia is determined by the plasma creatinine value reaching 707umol / L and urinary nitrogen reaching 30mmol / L or more. In addition, when the endogenous creatinine clearance rate is <10ml / min, dialysis therapy is required. However, as long as the following two indicators of the patient are normal, renal function and drainage function, even if the creatinine exceeds the standard, dialysis treatment may not be required immediately. First: urine output is in the Department of Nephrology, doctors often say to patients "there is hope in urine"! It can be seen that an important indicator of uremia is oliguria or anuria. Clinically, some patients with nephropathy have a clear urine volume of more than 2000 ml, but they blindly take "creatinine greater than 707" as the standard and believe that they have uremia, which is a bit too anxious. Normal urine output means normal kidney drainage and normal urine production, which means that renal tubular reabsorption function and glomerular filtration function have not been seriously damaged. Second: Kidney volume The judgment of kidney size has important clinical significance. The kidney shrinks or enlarges, which can indicate kidney disease. Usually kidney B-type ultrasound examination can know whether the kidney has kidney atrophy, and this examination method does not damage the patient. The normal value of renal ultrasound is: the average adult normal kidney size is about 10 ~ 12cm long; 5 ~ 6cm wide; 3 ~ 4cm thick. Kidney disease really develops into the uremic stage, which means that more than 80% of the nephrons are atrophy and necrosis, and the kidney volume will be seriously reduced. Therefore, patients with normal kidney volume despite thousands of creatinine may be caused by "temporary" reasons such as infection, hypertension, and drug damage. As long as these "temporary" causes are resolved, creatinine will naturally fall to normal levels. Note: If the long-term creatinine value is too high, exceeding 707umol / L, you must go to the hospital in time. As long as these two indicators are normal, it means that the remaining nephrons can still bear most of the human needs. At this time, blindly lowering creatinine is not the key, and the real cause of the increase in blood creatinine is eliminated to prevent future problems, and protecting the nephron is the key! Therefore, when choosing dialysis for patients with nephropathy who have high creatinine, they must pay attention to these two indicators, and communicate with doctors more, and strictly follow the doctor's instructions for treatment according to their own kidney function. Otherwise, once you start dialysis, you may never go back! If you have any related problems such as kidney disease, you can directly [Private Message] Professor Mo Feifan
Dialysis kidney friends have a great principle in diet, that is: control the amount and supplement nutrition, that is, control the intake of salt, phosphorus, potassium and water, and ensure the supplement of calories and high-quality protein. So how should we eat in order to maintain kidney health? Excessive salt intake can easily cause blood pressure to rise. It is recommended to choose fresh food and reduce the use of seasonings. Can’t stand the “clear soup and wispy water” can also choose to use fresh ingredients such as onion, ginger and garlic for seasoning, and also reduce the consumption of pickled products ha ~ For kidney friends, high phosphorus is gray is often easy to cause bone lesions , Itchy skin and irritation of hyperthyroidism and other issues. So-to adequately dialysis and avoid intake of foods with high phosphorus content, such as nuts, animal offal, etc. In addition, remember to eat phosphorus-lowering drugs when eating. High blood potassium is likely to cause arrhythmia, which will cause more serious harm. Therefore, blood potassium must be controlled as much as possible to 3.5-5.5mmol / L, and the changes of serum phosphorus and potassium should be monitored regularly. Ps: Potassium ions in vegetables are very soluble in water. Before cooking, it is best to scald the vegetables with boiling water for 3-5 minutes, then fry in oil or cold salad, so as to remove large amounts of potassium ions in food. Although drinking more water seems to be our recognized way to good health, but-for dialysis kidney friends, it is necessary to control the water intake Ha ~ because the intake of water will affect the weight, it is recommended that kidney friends The weight gain before secondary dialysis is based on the principle of not exceeding 5% of dry weight. Calories are the basic needs of the body. If the intake is insufficient, it will not only cause malnutrition, but also increase the kidney burden. However, it is best to eat cereals and eat less fat. Ensuring adequate and sufficient high-quality protein and the intake of high-quality protein are beneficial to the prevention of infection by kidney friends and enhance the body’s resistance. Common protein-rich foods are: milk, eggs, fish, lean meat and so on.
For uremic patients who have just started dialysis, the following complications may sometimes occur: ① allergic reactions: individual patients are allergic to the dialysis tubing or dialyzer used, may cause burning, difficulty breathing, choking dying, itching, urticaria , Abdominal cramps, diarrhea and other symptoms. ②Comprehensive certificate of dialysis imbalance: It is caused by the rapid decrease of solute concentration in the blood during dialysis, which causes the osmotic pressure difference between blood and brain tissue. Mild cases have headache, restlessness, nausea and vomiting, and muscle spasms. In severe cases, disorientation, seizures, and coma may occur, often accompanied by changes in EEG. ③ Diabetic hypotension: It often occurs due to excessive ultrafiltration and insufficient blood volume, application of antihypertensive drugs, dialysis with acetate, and eating during dialysis. ④ High blood pressure during dialysis: mostly caused by water and sodium retention, improper volume control or increased renin-angiotensin. ⑤ Arrhythmia: The main causes are coronary heart disease, heart failure, electrolyte disturbance, uremic cardiomyopathy, anemia and hypoxemia. Mostly due to changes in serum potassium and calcium. Some patients are caused by a decrease in blood pressure during dialysis and a decrease in coronary circulation. ⑥ Muscle spasm: mostly caused by low blood pressure, excessive ultrafiltration, the patient’s weight after dialysis is lower than dry weight or low sodium dialysis.
Because dialysis mainly solves the water load and toxins in the body, in addition to regular hemodialysis, maintenance hemodialysis patients must also actively correct renal anemia, renal hypertension, electrolyte acid-base balance disorders, renal bone disease, high Lipemia and other complications, so after dialysis often need to take the following drugs: (1) to correct metabolic acidosis: mainly oral sodium bicarbonate (NaHCO3), commonly known as baking soda. (2) Antihypertensive therapy: According to the patient’s blood pressure, individual antihypertensive therapy can be done. Maintain the blood pressure of dialysis patients as low as 140 / 90mmHg. (3) Treatment of anemia: Most patients need to apply recombinant human erythropoietin (rHuEPO) to correct anemia. Patients with iron deficiency need iron supplementation. Intravenous iron supplements are preferred. If intravenous iron supplements are allergic, iron supplements can be taken orally, mainly ferrous succinate and ferrous sulfate. (4) Treatment of hypocalcemia, hyperphosphatemia, and renal osteopathy: most patients with uremia are associated with abnormal bone metabolism. According to laboratory results, hypocalcemia can be administered with an appropriate amount of calcium; hyperphosphatemia can be Oral phosphorus-lowering drugs, such as calcium carbonate, lanthanum carbonate, and thiram; for renal osteopathy, calcitriol can be taken orally according to the level of the entire parathyroid hormone, and if necessary, calcitriol shock treatment. (5) Treatment of hyperlipidemia: Hyperlipidemia is also a common complication for dialysis patients. Statins not only have a lipid-lowering effect, but also have a plaque stabilizing effect. (6) Others: ① Patients with diabetic renal failure need to reduce insulin dosage accordingly with regular dialysis; ② Hyperuricemia usually does not require medical treatment, but if gout, 0.1 g of allopurinol is taken orally, 1-2 per day Times; ③ itchy skin: oral antihistamines to control hyperphosphatemia and intensive dialysis, effective for some patients.
In 2016, I, a rural child, a 21-year-old girl who had just stepped into the society from campus, filled my heart with joy and thought that I could pursue my dream in the future. The journey of life was rough until one day, I dragged my tired body to the toilet. The moment I saw gross hematuria in the toilet, I was dumbfounded. With a fearful heart, I quickly went to the hospital to check: urine protein 2+, creatinine 150, renal insufficiency! Since then I have become a patient with chronic kidney disease. The condition has been repeated for more than 4 years, and I have been treated in my local hospital for more than 4 years. The fluctuation of the blood creatinine range has been controlled at about 200-300. However, due to gynecological problems, a lot of bleeding occurred a month ago. During this period, creatinine rose to 523. The spirit was very poor, the body was weak, lack of appetite, and had a strong vomiting. I will be transferred to hospital immediately! ” Why did Dr. Bo Lan say again, let me know that I was seriously ill, but at that moment, I was very calm. Destiny seems to be joking with me. I was only 25 years old. Considering that I was still young and still have a long way to go, I didn’t want to spend my whole life on dialysis in the future, so I refused dialysis and chose a long way to seek medical treatment. & nbsp. & nbsp. I am actively looking for relatives and contacting friends, and my parents are always with me. After inquiring about it, I finally learned that the Chinese medicine treatment method of Beijing Lianke Traditional Chinese Medicine Nephrology Hospital was outstanding, and I came here for consultation and hospitalization. After hospitalization, my mood fluctuated greatly, and I lost my enthusiasm for life and work. At one time, I often lay in a hospital bed, unwilling to communicate with others, and the parents who were beside me were also anxious. I know this is bad, but at that time, I just wanted to be quiet. The doctors and nurses here are very responsible. I often take the initiative to talk to me about my daily life, which has greatly relaxed my mind. The attending physician will often say something that makes me happy, making me feel that the status quo is not that bad. After a week of treatment, problems such as complexion and fatigue have been significantly improved, and under the advice of a doctor, he stayed for more than a week before being discharged from the hospital. At present, he has been taking Chinese medicine for conditioning and his condition is stable. At the age of 25, I am grateful for recalling this sudden medical experience. With the support of family and friends, I have gone through a hard and memorable journey. What I want to say is that I still love life, and the dream of the future has not faded, and it is even more tangy.
Although the incidence of peritoneal dialysis-related peritonitis is significantly reduced, it is still one of the most common complications of peritoneal dialysis. It can cause uremic patients to eventually withdraw from peritoneal dialysis treatment. Severe peritonitis increases the hospitalization rate of dialysis patients and even leads to death . However, it should be emphasized that the principle of integrated treatment of chronic kidney disease should be emphasized in the process of renal replacement therapy. If the patient has related complications during the process of peritoneal dialysis, hemodialysis needs to be transferred or if he has the opportunity to undergo kidney transplantation, Patients should be advised to take appropriate treatment in a timely manner. In the same situation, if the patient has discomfort after hemodialysis, he can also be switched to peritoneal dialysis treatment; after renal transplantation, the treatment fails and can be changed to dialysis or hemodialysis. The ultimate goal of the conversion of the three is to achieve the best long-term survival of uremia patients. What are the precautions in the daily life of peritoneal dialysis patients? Once peritoneal dialysis, it will be a long-term treatment process, and it is home treatment. The first step is to prevent the occurrence of peritonitis. If symptoms of peritonitis occur, you should seek medical attention in a timely manner. Second, we must pay attention to the problem of water and salt control. Prevent edema and prevent overload of body fluids. In addition, as a patient, he should strictly record his own indicators and the drugs he takes to prepare for adjustment of the treatment plan at any time. The last is to encourage patients to return to society and live in the sun like a normal person.
First of all, kidney disease is a latent chronic killer, and your kidneys are spoiled unconsciously. The most serious illness is uremia. Ordinary people often think that this step is a dead end, and a thick family is OK. If you change your kidneys and your family is thin, you have to wait for death. But after all, only a very small number of people have uremia, and most of the patients are other types of kidney disease, such as nephritis, nephrotic syndrome, kidney stones and so on. Even if you have uremia, you are not dead. At present, the country implements medical insurance for serious diseases of uremia, and the medical insurance is reimbursed for the most part. The cost of dialysis is not personally paid out. If you have financial conditions, you can still wait for a kidney transplant. How long can dialysis and transplant live? There are many people who have been dialyzed and transplanted for more than 30 years. Rather than calculating how long you can live without being panicked all day long, it is better to spend more time with your family, enjoy every day of your life, and travel to where you want to go. What’s more, many of our kidney patients are still a long way from the last stage. As long as you don’t work hard and work hard, you can fully cooperate with a doctor to enhance physical exercise in your lifetime, and avoid going to the late stage of uremia. In addition to believing in regular doctors, regular treatment, and not superstitious, the usual sense of self-protection is also very important. First of all, don’t take medicine casually. Health care products, no matter where you look for home remedies, do n’t try “baicao” because you are not a “Shen Nong”. Liver and kidney are the first to be injured by various medicines. Some medicines are often not clinically tested, and even doctors cannot determine whether they can be taken, so it is better to be cautious. Kidney disease is difficult to break roots, and continuous rooting does not mean that kidney function cannot be stabilized. As long as the kidney function is always sufficient, even if the root is constant, it can satisfy the normal life. Secondly, even if the condition is stable, a regular review of about 3 months is necessary. Some of our patients always want to cut off the roots because they think that the indicators will never be ignored after turning negative. This is not enough. Even if the indicators are very stable, or even all overcast, they must be reviewed regularly. Re-examination items such as urine routine, 24-hour urine protein quantification, blood pressure, renal function, blood routine, renal ultrasound, electrolytes, etc. are some of the more basic items. In addition, life planning, mentality adjustment, not too tired, do not stay up at night, usually exercise, do not eat too salty, etc., these are daily maintenance work. Finally, and most importantly, always have a sense of awe and do n’t mess around. In fact, many of us will fall into extremes just because we are too scared. Just think about it, why should you be so afraid? There are more than 100 million people with kidney disease in our country, and there is no special statistics on the number of uremia. It is estimated to be more than 1 million. Even if it is unfortunately the 1%, the doctor is not helpless, there is a strategy. Think of it this way, God doesn’t actually have a very harsh patient with kidney disease. Do your utmost perseverance, strive for the life is not poisonous and impenetrable is the king!
Peritoneal dialysis kidney friend asks: Can the peritoneal dialysis solution be used up once and can be used next time? Answer: The peritoneal dialysis solution can not be used up once. First of all, the basic components of peritoneal dialysate include glucose, sodium ions, chloride ions, calcium ions, magnesium ions, and acetate, etc., which are rich in nutrients and suitable for bacterial reproduction when the temperature is appropriate. Secondly, the peritoneal dialysis patients’ room for peritoneal dialysis is not a sterile environment, and it is difficult to ensure that the peritoneal dialysis solution is not contaminated during the peritoneal dialysis operation. Once the peritoneal dialysate is contaminated, bacteria will multiply during storage and be poured into the abdominal cavity during the next use, there is a risk of causing peritonitis. Therefore, the remaining peritoneal dialysate should be discarded and should not be used next time. Therefore, don’t continue to use unused peritoneal dialysis solution for the sake of saving to avoid infection.
& nbsp. & nbsp. & nbsp. & nbsp. & nbsp. & nbsp. & nbsp. How should the peritoneal dialysate be heated? Peritoneal dialysis patients should infuse 0.5 ~ 2.5L of peritoneal dialysate into the abdominal cavity every time they perform peritoneal dialysis. If the peritoneal dialysate is too cold or too hot, it may cause abdominal discomfort or abdominal pain. Therefore, the peritoneal dialysate should be heated, generally should be heated to about 37 ℃, but should be adjusted according to the patient’s sensitivity to the temperature of the peritoneal dialysate, it is also necessary to warm the peritoneal dialysate in summer, the heating temperature can be appropriately reduced 1 ~ 2 ℃. It is recommended to use dry constant temperature heating box for heating peritoneal dialysis solution. It is forbidden to use constant temperature water bath box to prevent the peritoneal dialysis solution packaging bag from being damaged. The catheters and interfaces on the peritoneal dialysis solution and the packaging bag are contaminated. Peritonitis wind. The constant temperature heating box should be tested and calibrated at least once a year to avoid overheating of the dialysate due to the failure of the constant temperature heating box, which may cause unknown physical and chemical changes of the peritoneal dialysate and affect the dialysis effect, or cause the patient’s body temperature to increase. Do not remove the outer packaging when the peritoneal dialysate is heated.
During hemodialysis, about 20% to 35% of patients will have muscle spasm symptoms-mainly manifested by sudden tonic contraction of muscles, and the pain will be more intense, which lasts for seconds or even minutes. If timely and effective intervention is not available, the patient ’s compliance with hemodialysis will be significantly reduced. 1. The main manifestations of muscle spasm are gastrocnemius muscle, intercostal muscles, cremaster muscles, back muscles, abdominal muscles, upper and lower limb muscle groups, and hand muscles. Multiple attacks with lower limb muscles. 2. Measures for prevention and treatment of muscle spasms 1. Emergency treatment: keep warm and massage the spasms. Targeted treatment measures according to the reason: slow blood flow, suspend ultrafiltration, rapid intravenous infusion of saline, oxygen inhalation, intravenous calcium gluconate injection, etc. If the symptoms do not improve, the treatment can be ended. 2. Psychological dredge: When patients suffer from muscle spasms, they are prone to anxiety and nervousness. Talk to the patient to do a good job of comforting, distract their attention, and reduce tension. Pay attention to observe the puncture of the lateral limb of the internal fistula to avoid bleeding from the puncture point due to the patient’s pain and intolerance when sitting up or moving the limb and pulling the tube. 3. Correctly assess the patient’s dry weight: & nbsp. & Nbsp. ① Comprehensively assess the patient’s water load before each treatment. ②Patients without obvious water and sodium retention and muscle cramps should adjust dry weight in time. ③Guide the patient to master the weight measurement method, fix the weight scale, and fix the clothes to measure, to avoid excessive ultrafiltration due to clothing changes, eating and other factors, and calculate the ultrafiltration correctly. ④Each ultrafiltration volume should be less than 5% of dry weight. Avoid muscle spasm caused by excessive ultrafiltration. 4. Individualized dialysis plan: adjust the dialysis plan and use individualized dialysis. Such as sequential dialysis, sodium curve dialysis, ultrafiltration curve dialysis; use a dialyzer with good biocompatibility; increase the frequency of dialysis. 5. Observation and care during dialysis: Observe patients closely during dialysis, and should pay more attention to patients with previous history of muscle spasm. During dialysis, such patients should be visited more often, asking if there is any discomfort, closely observing changes in vital signs, and increasing the number of blood pressure measurements if necessary.