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How to protect residual renal function in uremic dialysis patients?

There are some misunderstandings about the urine volume of dialysis patients and even non-dialysis medical personnel. It is an inevitable trend for uremic dialysis patients to reduce urine volume until anuria or oliguria, so many people do...

How to protect residual renal function in uremic dialysis patients?

Jan 08, 2018 by Kidney Disease Expert

There are some misunderstandings about the urine volume of dialysis patients and even non-dialysis medical personnel. It is an inevitable trend for uremic dialysis patients to reduce urine volume until anuria or oliguria, so many people do not attach importance to the urine volume of dialysis patients, think that anyway dialysis, urine volume is to be reduced, there is no matter whether there is urine volume. Clinical experience tells us that in the face of different dialysis patients, patients with some urine volume after dialysis have higher survival status and quality of life than those without urine. So how to protect the residual renal function of the patient is particularly important, and the following measures will help to protect the residual renal function of the patient:

How to protect residual renal function in uremic dialysis patients?

1. To avoid excessive ultrafiltration dehydration. Because of toxins in hemodialysis patients with excessive toxins, coupled with the salt intake is not controlled, if the dialysis is not enough, the dry mouth is very obvious because of the high osmotic environment, if not limiting water intake, leading to excessive weight gain during dialysis, too Fast, in order to maintain dry weight, often in dialysis unit time ultrafiltration dehydration too much, too fast, too late to compensate the body, leading to a sharp decrease in renal perfusion, urine output decreased rapidly or even without urine, which is leading to rapid residual renal function One of the most important factors of loss. Faced with this situation, we must strictly control dry weight, weight gain during dialysis can not be too much, it is best not to exceed 5% of dry weight, dry weight for elderly and wasting more to strictly control the dry weight. Similarly, peritoneal dialysis patients, sometimes patients with obvious edema, in order to increase the amount of ultrafiltration, frequent use of high concentrations of peritoneal dialysis, dialysis patients will accelerate the loss of residual renal function in dialysis, peritoneal dialysis patients should try to avoid the use of 2.5 % Peritoneal dialysis solution, for use, need to weigh the pros and cons.

2. To avoid the application of nephrotoxic drugs. Although patients with uremia into the dialysis, but most patients still have some residual renal function, in clinical work, we should try to avoid the use of nephrotoxic drugs. Such as antipyretic analgesics, aminoglycoside antibiotics, etc. should be avoided in clinical practice, because the use of nephrotoxic drugs will reduce the glomerular filtration rate, resulting in the rapid loss of residual renal function.

3. Kidney protection drug application. Both hemodialysis patients and peritoneal dialysis patients, in close monitoring of side effects under the premise, in order to protect the patient's residual renal function, it is recommended to use angiotensin converting enzyme inhibitors or angiotensin II receptor antagonists, in addition to playing antihypertensive, Reversal of ventricular remodeling, but also help to protect the patient's residual renal function.

4. Proper use of diuretics. In addition to using the above methods, patients still have urine output after dialysis, Climb diuretics can also be considered to protect the patient's residual renal function. This is particularly important for peritoneal dialysis patients, an important advantages of peritoneal dialysis is that its hemodynamics is stable , it has the advantages of protecting residual renal function , and it is recommended to use the climbing diuretic on the basis of the advantage of protecting residual renal function .

Dialysis is one of the most important treatments for uremic patients. If we can guarantee the adequacy of dialysis, we can also protect residual renal function, delay the loss of residual renal function and maintain partial urine volume, which will undoubtedly improve the quality of life and improve long-term prognosis.

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