Dialysis therapy is an artificial treatment method that replaces kidney function, primarily used for patients with severe renal failure. When the kidneys are unable to eliminate waste products and excess water from the body, dialysis can simulate the filtration function of the kidneys, preventing the accumulation of metabolites that could lead to poisoning or edema.
This therapy is divided into two main types: hemodialysis and peritoneal dialysis. The choice of appropriate modality depends on the patient's physical condition and medical situation. The core goal is to maintain fluid balance, regulate electrolytes, and delay the progression of end-stage renal disease complications.
Hemodialysis involves drawing blood out of the body through a dialysis machine, filtering waste products using a semi-permeable membrane, and then returning the purified blood to the body. This process requires establishing vascular access, such as an arteriovenous fistula or central venous catheter, typically performed 2-3 times a week for about 4 hours each session.
Peritoneal dialysis uses the peritoneum as a filtering membrane. Dialysis fluid is injected into the abdominal cavity to absorb waste products and then drained out. It includes continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). Patients can perform it at home, but strict aseptic procedures must be followed.
Primarily indicated for patients with chronic kidney disease stage 5 (end-stage renal disease) or acute kidney injury leading to uremia. When serum creatinine exceeds 7 mg/dL, severe hyperkalemia, or fluid overload occurs, physicians will evaluate the need to initiate dialysis.
Some patients with severe metabolic acidosis or drug poisoning may also undergo emergency dialysis. Contraindications such as inadequate vascular conditions or severe infections must be ruled out before proceeding.
Hemodialysis must be performed in a medical facility, using 4-6 liters of dialysate per session, with blood flow controlled at 200-300 mL/min. The dose is adjusted based on the patient's weight and waste accumulation, with a target clearance rate (Kt/V) of over 1.2.
Peritoneal dialysis requires exchanging dialysate 3-4 times daily, each time instilling 1.5-3 liters. Chronic patients usually undergo long-term treatment, while acute cases may use it for a short period.
Peritoneal dialysis can more evenly clear middle-molecular-weight toxins, while hemodialysis is more effective at removing large molecules such as β2-microglobulin. Both methods require dietary management to achieve optimal results.
Common side effects of hemodialysis include hypotension (occurring in 30-50% of cases), muscle cramps, and fatigue. Long-term use may lead to bone calcification or nutritional deficiencies, requiring regular monitoring of calcium-phosphorus metabolism.
Risks associated with peritoneal dialysis include peritonitis (annual incidence of about 10-15%), protein loss, and metabolic acidosis. Close observation of dialysate clarity and body temperature changes is necessary. Strict sterile procedures are essential to reduce infection risk.
Contraindications include uncontrolled bleeding tendencies, severe edema with heart failure, or peritonitis during peritoneal dialysis. Patients with pacemakers or poor vascular conditions need tailored treatment plans.
Patients must adhere to dietary restrictions, including low potassium and sodium diets, water intake limitations, and protein management. On dialysis days, overeating should be avoided to prevent increased cardiac and pulmonary burden.
When using phosphate binders, erythropoietin (EPO), and other medications, dosage adjustments are necessary to avoid excessive clearance. For example, iron supplements may need increased frequency due to dialysis-related losses.
Patients undergoing surgery or chemotherapy should have their dialysis schedule adjusted in advance to prevent drug accumulation. When combined with anticoagulants, coagulation parameters should be monitored to prevent bleeding.
Long-term follow-up shows that regular hemodialysis can increase the 5-year survival rate to 65-75%, and peritoneal dialysis patients have a survival rate of approximately 50-60%. The effectiveness varies depending on patient age and complication management.
Clinical studies confirm that dialysis effectively reduces serum creatinine and blood urea nitrogen, improves anemia and neurological symptoms. However, attention should be paid to the phenomenon of "dialysis inadequacy" during treatment gaps, which may affect long-term prognosis.
Kidney transplantation is a definitive treatment but requires immunosuppressants and waiting for a suitable organ. Home hemodialysis machines (HHD) offer another option but require trained personnel for operation and maintenance.
For patients with acute kidney injury, continuous venovenous hemofiltration (CVVH) is a common short-term treatment in intensive care units.
Before hemodialysis, patients need vascular access surgery (such as arteriovenous fistula creation), which typically requires 4-6 weeks for vascular maturation before use. On the day of treatment, avoid wearing tight clothing and inform medical staff if there is a fever or redness/swelling at the fistula site.
How should I respond if blood pressure drops suddenly during dialysis?Hypotension is a common side effect. If dizziness or cold sweat occurs during treatment, immediately inform medical staff to adjust dialysate composition or reduce flow rate. Daily, control water intake, follow medical advice for salt supplementation, and avoid consuming excessive sugary foods an hour before treatment to reduce risk.
Can I perform light exercise after dialysis?Doctors usually recommend avoiding strenuous activity within 30 minutes after dialysis but allow gentle exercises such as walking. The arm with the fistula should avoid heavy lifting or blood pressure measurement. It is advisable to check the fistula's vibration daily; if abnormal, seek medical attention immediately.
How to control potassium intake during the interval between dialysis sessions?Hyperkalemia can trigger arrhythmias. Patients should avoid high-potassium foods such as bananas, avocados, and mushrooms. Cooking methods like boiling and discarding the water can reduce potassium content. Daily potassium intake should be kept below 2000 mg, with regular serum potassium monitoring.
How do long-term dialysis patients handle the risk of fistula frostbite in winter?The fistula site should not be exposed to cold environments for prolonged periods. During bathing, water temperature should not exceed 40°C. Wearing specialized thermal sleeves can help maintain local blood flow. If skin discoloration or temperature drop is observed, stop cold or hot stimuli immediately and notify the medical team to assess thrombosis risk.
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