Chronic Kidney Disease Stage 5, Patients Should Not Worry About Dialysis, They Can Still Continue To Take Medication, The Focus Is On 5 Types Of Drugs

Chronic kidney disease (CKD) is generally divided into five stages based on the estimated or detected glomerular filtration rate (GFR), among which GFR<15ml/min is CKD stage 5, which is also the advanced stage of chronic kidney disease, called the end-stage kidney disease (ESRD). Those with chronic kidney disease who have received dialysis or kidney transplantation have reached stage 5 of chronic kidney disease (CKD stage 5). Because of this, some patients may think that: when CKD stage 5 is reached, patients should undergo dialysis or kidney transplantation immediately! Is it true?

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      The recommendations of the previous relevant guidelines are as follows: for chronic kidney disease that gradually develops from diabetic nephropathy caused by diabetes, when the GFR drops below 15ml/min, the patient should receive maintenance dialysis treatment; For chronic kidney disease that develops gradually, when GFR drops below 10ml/min, patients should also receive maintenance dialysis treatment. The guidelines also pointed out that for those with chronic renal failure with special complications (such as severe hyperkalemia or acute left heart failure, etc.), maintenance dialysis treatment may be required in advance. However, there is still controversy about when to start maintenance dialysis in patients with stage 5 chronic kidney disease. Studies have shown that in terms of quality of life and survival time, receiving maintenance dialysis early is not better than maintenance dialysis which can be delayed. As for when to start maintenance dialysis treatment, in addition to GFR, it should also be combined with the patient's primary disease, complications, comorbidities, and other underlying diseases. Conclude and make decisions.

      We found that the GFR of some patients with stage 5 chronic kidney disease has dropped to 10-15ml/min or even 5-10ml/min. The binding force and other indicators are all adjusted to a reasonable range, and it is still possible to go without dialysis for a long time, and the patient's self-feeling and quality of life are relatively good. If maintenance dialysis treatment is received too early, the subsequent loss of drainage function and various complications related to dialysis will cause absolute dependence on dialysis and affect the quality of life of patients.

      Therefore, those patients who have just arrived at the fifth stage of chronic kidney disease, do not rush to dialysis, and the nephrologist who has been treating them should make a decision based on the specific condition. We believe that there are still a considerable number of CKD stage 5 patients who can continue to take the following medications while paying attention to the changes in their condition and regular inspections of related indicators.

1. To treat high blood pressure, but also to prevent hypotension

      By CKD stage 5, high blood pressure is usually present, and patients often have very high blood pressure. High blood pressure can cause patients to complicate or aggravate heart failure and cerebrovascular accidents, thereby increasing the risk of death. Therefore, it is necessary to continue to use antihypertensive drugs. Except for sartan or pupil antihypertensive drugs that are not suitable for use, other antihypertensive drugs can be used according to the specific condition, and "divine" antihypertensive drugs should be preferred. Be sure to lower your blood pressure, but you can't lower your blood pressure too low, let alone hypotension.

2. To correct anemia, but also to prevent excessive hemoglobin

      At stage 5 of CKD, anemia, that is, renal anemia usually occurs, and most of the concurrent anemia at this time is moderate or above anemia. The decreased quality of life of patients is also related to this complication, which can also bring about many other problems, such as aggravating heart failure, susceptibility to infection, and promoting disease progression. Therefore, it is necessary to continue to use anti-anemia drugs. In addition to erythropoietin or roxadustat, drugs such as iron or folic acid should also be used at the same time. Be sure to correct the hemoglobin to between 110-120g/L, but also prevent the effects of high hemoglobin, such as causing high blood pressure.

3. To correct calcium and phosphorus disorders, but also to prevent hypercalcemia

      At the 5th stage of CKD, calcium and phosphorus metabolism disorders and secondary hyperparathyroidism are usually complicated, manifested as low calcium (Ca), high phosphorus (P), and elevated parathyroid hormone (PTH), etc. These abnormalities will affect the body causing further damage. Therefore, it is necessary to continue to use drugs to correct it. You can choose calcium-phosphate binders (such as calcium acetate) and calcium-free phosphorus binders (such as lanthanum carbonate), as well as active vitamin D3 (such as calcitriol). Be sure to correct the patient's blood calcium, blood phosphorus, and PTH within a reasonable range, but also prevent hypercalcemia, which will cause damage to the body due to vascular calcification.

4. To treat hyperkalemia, hypokalemia should be avoided

      At stage 5 of CKD, hyperkalemia is often complicated. Mild hyperkalemia may be asymptomatic, while moderate to severe hyperkalemia is not as simple as symptoms, but it can cause arrhythmia and even cardiac arrest. Therefore, it is necessary to avoid or correct hyperkalemia during medication. For example, sartan or peril drugs, potassium-sparing diuretics, and other drugs that can cause hyperkalemia should be avoided as much as possible. Once hyperkalemia occurs, you should choose to use related potassium-lowering drugs including furosemide, sodium bicarbonate, or insulin at first time, but you should also prevent hypokalemia because hypokalemia will also cause bodily harm.

5. Acidosis should be corrected even without symptoms

      At stage 5 of CKD, metabolic acidosis is usually accompanied by a decrease in carbon dioxide binding capacity, and metabolic acidosis will further cause damage to multiple organs and accelerate the progression of renal failure. Therefore, it is necessary to continue to use alkaline drugs such as sodium bicarbonate. The commonly used drugs are sodium bicarbonate tablets or 5% sodium bicarbonate injection. Regardless of whether there are gastrointestinal and other symptoms such as nausea and vomiting, patients with CKD stage 5 need to correct acidosis.

      The above only talked about the five aspects of drug treatment and precautions. However, at the stage of CKD 5, the complications and abnormal indicators of kidney disease patients are far more than these. For other complications and abnormal indicators, patients should be actively treated and corrected. At the same time, we must also pay attention to the prevention and treatment of heart failure and the protection of forearm blood vessels, to lay a solid foundation for maintenance dialysis in the future, to better improve the quality of life, and prolong life expectancy.

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