Post Date December, 03 2023
Patients with uremia all hope that their kidneys can still be saved. However, in the late stage of renal failure, if necessary measures are not taken, even the best kidney function will disappear with dialysis.
Key points
So uremic patients are tightly intertwined with a word - residual kidney function.
It almost determines whether end-stage kidney disease patients can avoid dialysis and how long they can live after dialysis.
Residual renal function (RRF) refers to the ability of the autologous kidneys to clear water and uremic toxins in uremic patients, including end-stage renal disease (ESRD) patients undergoing hemodialysis (HD) or peritoneal dialysis (PD).
The protection of residual renal function is closely related to the treatment methods of uremic patients, longer survival time for hemodialysis or abdominal dialysis patients, fewer complications, and better quality of life.
Protecting residual kidney function is one of the primary goals for the treatment of end-stage kidney disease patients. The reason is simple:
Patients with good residual kidney function do not need dialysis.
Almost a patient, happily undergoing dialysis
The worst patient, suffering from dialysis
(Simultaneously facing higher mortality rates)
It's also uremia, the difference is so big.
Kidney disease magazine has published an article that reveals ways to protect residual kidney function. Let's take a look together.
What to do before dialysis
1、 4 comorbidities
Under the same external conditions, some diseases themselves have a rapid decline in renal function. For example, the renal function of patients with diabetes nephropathy will decline faster than that of patients with glomerulonephritis.
We cannot control the disease type, but we can control the comorbidities! Once these four symptoms are under control, you have passed the first hurdle of protecting residual kidney function
1. Renal artery stenosis
2. Heart failure
3. Obesity
4. High uric acid
2、 Depressurization
As long as there is no hypotension, take Puli type antihypertensive drugs, or sartan type antihypertensive drugs as long as you should, and do not stop taking them.
3、 Time of starting dialysis
Previous backward experience suggests that early dialysis provides better protection for residual kidney function and better prognosis.
However, the results from a randomized controlled trial IDEAL study suggest that compared to late dialysis (filtration rate between 5-7), early dialysis (filtration rate between 10-14) does not reduce mortality. (Some developed countries have started dialysis with creatinine 400 and still need improvement)
I have seen many patients without complications, with creatinine levels of 600 or even 500, who urgently need dialysis, confused! Especially doctors, when patients don't understand the disease, you even make them jump into the pit and reflect
What to do after dialysis
4、 Dialysis mode
If dialysis is necessary, it is generally believed that residual kidney function decreases faster in hemodialysis patients (0.18-0.33mL/min/month) than in peritoneal dialysis patients (0.05-0.303mL/min/month).
That is to say, if the hygiene situation at home is good, try to choose abdominal dialysis.
The selection of peritoneal dialysis solution with neutral acidity and low glucose degradation products helps to protect residual kidney function. Compared with other conventional peritoneal dialysis fluids, mecodextrin peritoneal dialysis fluid may help protect residual renal function in patients undergoing peritoneal dialysis.
For the protection of residual renal function in hemodialysis patients, high throughput polysulfone membrane dialyzers are better than cellulose dialyzers.
5、 Diet during dialysis
It is not yet clear.
I really don't know... how much protein is good for dialysis patients? There is no reliable conclusion yet.
Some studies have shown that protein nutrition in dialysis patients should be doubled compared to other kidney disease patients, and eating it like normal people is beneficial for the kidneys.
Another study suggests that protein should be eaten less and more to protect the kidneys.
Before the debate among the world's top experts has come to an end, it's better not to treat yourself unfairly. Eat eggs and lean meat if you want.
6、 Nephrotoxic drugs
Dialysis patients, especially those undergoing peritoneal dialysis, should avoid using non-steroidal anti-inflammatory drugs, aminoglycoside antibiotics, and contrast agents.
For hemodialysis patients, oral administration of acetyl N - acetylcysteine before use of contrast media may help protect residual renal function.
Finally, let me emphasize that protecting residual renal function (RRF) is one of the primary goals for the treatment of uremic patients.
What is the second one? It is the part of the kidney that repairs the damaged nephron's function.
Patients must remember that regardless of whether you have dialysis or not, only through correct and standardized traditional Chinese medicine treatment can creatinine be lowered to avoid dialysis. The above 6 points are only auxiliary suggestions before treatment, in order to strive for a chance of successful treatment when entering the treatment of restoring kidney function.
