Part1: Common Sense You Need To Master Before Kidney Dialysis

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When the words "uremia" and "dialysis" are mentioned, some friends who suffer from kidney disease are very nervous. In fact, the disease is not terrible, as long as you have a good understanding of the relevant knowledge and can actively treat it. The following common sense is shared with readers in need.

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1. What is the basic function of the kidneys?

The primary function of the kidneys is to filter and purify the blood, form urine, and expel unwanted waste and excess water from the body through urination. In addition, the kidneys can also regulate blood pressure; stimulate hematopoiesis, promote red blood cell production; activate vitamin D, maintain calcium and phosphorus balance, and maintain bone health; regulate electrolyte, acid-base balance.

2. What does uremia mean?

The popular understanding is that the kidneys basically do not work, and they do not work permanently. The precise official definition is an end-stage renal disease (ESRD), which refers to an irreversible drop in the glomerular filtration rate (eGFR) below 15ml/min/1.73m2.

3. What does glomerular filtration rate mean?

Glomerular filtration rate, abbreviated as GFR, is commonly understood as the ability of the glomeruli to filter blood.

Because of the complexity of accurately calculating the glomerular filtration rate, clinicians typically use computational tools to approximate a patient's glomerular filtration rate (eGFR).

4. What discomfort does uremia make?

We have just learned about the basic functions of the kidneys, so the symptoms after the kidneys strike can be roughly inferred:

1. Head - headache, fatigue, blurred thinking

2. Mouth - the smell of urea in the mouth, anorexia

3. Lungs - shortness of breath, wheezing

4. Stomach - nausea, vomiting

5. Urinary-urinary volume decreased, or the urine volume of some patients remained unchanged, but metabolic wastes remained in the body

6. Hands and feet - swollen

7. Skin - itchy skin

8. Severe fatigue and discomfort

5. How high should creatinine be for dialysis?

In general, most end-stage patients start dialysis at a glomerular filtration rate (eGFR) of 5 to 10.

6. When I have uremia, should I have dialysis immediately?

Dialysis is not necessary for uremia (eGFR less than 15). Some people have mild symptoms of uremia which may last for about 1-2 years during conservative treatment.

7. Is it better to have dialysis earlier?

Not really. If a patient with uremia feels good about himself, the indicators are temporarily controllable with drugs, and the compliance is high, then the doctor may let the patient undergo dialysis relatively later under close monitoring.

A study in the New England Journal of Medicine, a top medical journal, showed that later dialysis in uremia was no worse than earlier dialysis, with no significant difference in mortality, infection, cardiovascular disease, and dialysis complications. Of course, if a patient with uremia is in a poor state and has life-threatening conditions such as hyperkalemia, pericarditis, and progressive malnutrition that cannot be corrected with medication, dialysis is required immediately.

8. I heard that there is a place that can cure uremia and reduce creatinine. Should I try it?

Do not! Not only are you being cheated of money, but you may also lose your life! Although you will also see or hear that some patients have very high serum creatinine at first, as high as 500, 600, or even higher, after treatment, the creatinine has dropped to basically normal, and the glomerular filtration rate has recovered. Something happened! But these conditions are acute or subacute renal failure, not end-stage renal failure.

9. Once on dialysis, do I have to keep on dialysis?

Generally yes. Because the patient's own kidney function has been completely lost, continuous dialysis is required to remove waste and water. A successful kidney transplant can free the patient from dialysis. (Temporary dialysis support for acute renal failure, beyond the scope of this article)

10. Is there no other way to treat uremia besides dialysis?

There are three alternative treatment options for uremia:

Hemodialysis, peritoneal dialysis and kidney transplantation.

For the vast majority of kidney disease patients, all three methods can be selected, and they are all suitable. Kidney transplantation is usually the optimal solution when economic conditions permit and the conditions for transplantation are met. These three are not one or the other but complement each other. For example, a patient starts peritoneal dialysis or hemodialysis first and waits until the kidney source is stable before proceeding to kidney transplantation. Or hemodialysis or peritoneal dialysis may be performed more than ten years after kidney transplantation.

11. Peritoneal dialysis and hemodialysis, who is better?

It is currently believed that the expected outcomes between hemodialysis and peritoneal dialysis are comparable, and no one is better than the other, so the choice is mainly based on personal wishes and accessible medical resources.

12. Is dialysis finished? Not long to live!

no! Many patients may feel that once they develop uremia, they will be useless even if they survive. Not so. Compared with other end-stage diseases, end-stage renal disease is really "fortunate" among misfortunes. It might be inappropriate to say that. For example, it is very difficult to live a quality and long life regardless of whether the patient with advanced cancer is willing or not, whether he has money or not. In the end stage of kidney disease, as long as the patient is willing to cooperate and has a certain economic foundation, it is not difficult to live happily for decades.

13. How much does a kidney transplant cost?

Some kidney transplants can be reimbursed, and some cannot be refunded. For relative kidney transplantation, the patient pays about 100,000 out of his own pocket. For non-relative kidney transplantation, the patient pays about 300,000 out of his own pocket. Because patients cannot work for a long period of time after uremia, they can only pay but have no income, so planning their finances in advance is an important guarantee for a long and well-lived life.

14. Is an artificial kidney far away from us?

At present, we are more optimistic, and the one very close to the patient is home dialysis. With the popularization of home hemodialysis and home automated peritoneal dialysis, patients will have a higher quality of life than now. As for artificial kidneys, such as implantable artificial kidneys and pig kidney transplantation that everyone is looking forward to, we can keep our expectations, but there are still many problems that have not been solved, and it is too early for large-scale application.