Dialysis is a medical technique used to replace kidney function, primarily for patients with severe renal failure unable to properly filter waste products. It removes metabolic waste and excess water from the blood artificially, maintains electrolyte balance, and prevents uremic toxins from threatening life. This therapy is divided into two main types: hemodialysis and peritoneal dialysis, with the choice depending on the patient's condition and lifestyle.
The core goal of dialysis is to prolong life and improve quality of life, but it requires long-term commitment and strict medical management. Its applications include end-stage chronic kidney disease and acute kidney injury, serving as an important supportive therapy before and after kidney transplantation.
Hemodialysis involves guiding blood outside the body through a dialysis machine, where it exchanges substances with dialysis fluid via a semi-permeable membrane, removing waste products such as urea and creatinine. This process is typically performed 2-3 times a week, each session lasting about 4 hours, with vascular access established via an arteriovenous fistula or graft.
Peritoneal dialysis uses the patient's own peritoneum as a filtering membrane. Dialysis fluid is injected into the abdominal cavity, and waste products and excess water are removed through diffusion and osmosis. It is divided into Continuous Ambulatory Peritoneal Dialysis (CAPD) and Automated Peritoneal Dialysis (APD). Patients can perform the procedure themselves but must strictly follow aseptic techniques.
Primarily suitable for patients with Stage 5 Chronic Kidney Disease (end-stage renal disease), with Glomerular Filtration Rate (GFR) below 15 mL/min and accompanied by severe metabolic acidosis or hyperkalemia. Emergency dialysis is also required when acute kidney injury causes fluid overload or toxin accumulation.
Hemodialysis must be performed at a medical facility. The duration of each session is adjusted based on waste accumulation, with a standard frequency of three times per week, each lasting 4 hours. Dialysis dose is measured by the Kt/V value, with a target of at least 1.2 for hemodialysis.
Peritoneal dialysis requires 4-6 exchanges daily, each injecting 1.5-3 liters of dialysis fluid. The total replacement volume is adjusted according to fluid balance needs. In acute settings, Continuous Venovenous Hemofiltration (CVVH) may be used for gentler toxin removal.
Dialysis effectively delays the progression of uremia. Studies show that regular treatment can improve the 5-year survival rate of end-stage renal disease patients to 60-70%. Hemodialysis rapidly clears large-molecule toxins, while peritoneal dialysis, with continuous daily filtration, provides more stable blood pressure control.
Immediate side effects in hemodialysis patients include Dialysis Disequilibrium Syndrome, characterized by dizziness, nausea, and in severe cases, seizures. Hypotension occurs in 30-40% of patients during initial treatments, often related to excessive ultrafiltration.
Long-term risks include arteriovenous fistula infections, arteriosclerosis, and malnutrition. Peritoneal dialysis patients have an infection rate of about 20% annually, which may lead to peritonitis or fistula obstruction. Close monitoring of dialysis fluid changes is essential.
Contraindications include uncontrolled severe bleeding tendency, unhealed vascular access infections, and cardiac tamponade symptoms. Patients should monitor body weight and blood pressure daily, and strictly control sodium intake (<2000 mg/day) to prevent fluid overload.
Patients on anticoagulant therapy need dose adjustments of heparin, with ACT monitoring during dialysis. Severe hypovolemia or shock requires treatment suspension and management of primary symptoms.
When using erythropoietin (EPO), dosage adjustments are necessary as dialysis may accelerate drug metabolism. Oral iron supplements should be taken separately from meals to avoid interactions with phosphate binders.
Preoperative dialysis adjustments ensure serum nitrogen levels are controlled before surgery. Potassium-containing medications require close monitoring of serum potassium, as fluctuations may occur between dialysis sessions.
Large randomized controlled trials show that regular hemodialysis can extend median survival of end-stage renal disease patients to 5-10 years. Peritoneal dialysis is more effective in blood pressure control but carries a higher risk of protein-energy malnutrition.
The 2020 Cochrane review indicates that thrice-weekly hemodialysis reduces serum creatinine by about 60%, but phosphate binders are necessary to control serum phosphorus. Treatment effectiveness should be evaluated alongside kidney transplantation prospects, with patients on dialysis awaiting transplantation during the waiting period.
Kidney transplantation is the definitive cure but requires immunosuppressants and donor matching. Continuous Venovenous Hemofiltration (CVVH) is suitable for acute kidney injury, providing more stable toxin clearance.
Home peritoneal dialysis can replace traditional hemodialysis, but patients or caregivers must be trained and capable of self-care. In resource-limited areas, simplified dialysis options may be considered, with close biochemical monitoring.
Before the first dialysis session, the medical team will perform a comprehensive health assessment, including blood tests, cardiac evaluation, and vascular access creation (such as arteriovenous fistula or central venous catheter). Patients should understand the treatment process and adjust their diet and fluid intake to prevent blood pressure fluctuations or fluid overload during treatment.
How can common side effects during dialysis be alleviated?The most common side effect during dialysis is hypotension, often caused by rapid fluid removal. Medical staff will adjust dehydration levels or medications to mitigate this. Muscle tremors can be improved by vitamin B1 supplementation or adjusting dialysis fluid composition. Patients should report symptoms promptly for timely treatment adjustments.
What dietary precautions should be taken during dialysis?Patients should limit high-potassium foods (such as bananas, mushrooms) and high-phosphorus foods (such as processed foods), and consume high-quality protein sources (such as fish and soy products). Fluid intake must be strictly controlled, including hidden water in soups, fruits, and other foods, to avoid fluid overload.
What are the differences between home dialysis and hospital treatment?Home peritoneal dialysis requires training and self-operation by patients or caregivers, offering flexibility but requiring strict aseptic procedures. Hemodialysis is usually performed at a medical facility three times a week, each session lasting about 4 hours. The most suitable treatment mode is recommended based on vascular conditions, lifestyle, and self-management ability.
How can dialysis-related infections be prevented and vascular access lifespan extended?Daily inspection of the vascular fistula for redness, swelling, warmth, or lumps is essential. Avoid tight clothing that compresses the access. After treatment, applying pressure for 15-30 minutes at the needle site helps achieve hemostasis. Regular follow-up to assess fistula blood flow rate is necessary. If obstruction or infection occurs, surgical repair or replacement may be required.
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