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 and excess water from the body, dialysis mimics the filtration function of the kidneys, preventing the accumulation of metabolites that can lead to poisoning or edema.
This therapy is divided into two main types: hemodialysis and peritoneal dialysis. The choice of suitable modality depends on the patient's physical condition and clinical 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 using a semi-permeable membrane, and then returning the purified blood to the body. This process requires establishing a vascular access, such as an arteriovenous fistula or central venous catheter, typically performed 2-3 times per week, each session lasting about 4 hours.
Peritoneal dialysis uses the peritoneum as a natural filter, where dialysis fluid is injected into the abdominal cavity to absorb waste products and then drained. It includes Continuous Ambulatory Peritoneal Dialysis (CAPD) and Automated Peritoneal Dialysis (APD). Patients can perform the procedure at home, but strict aseptic techniques 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 and initiate dialysis.
Some patients may require emergency dialysis due to severe metabolic acidosis or drug poisoning. Contraindications such as inadequate vascular access or severe infection must be excluded before proceeding.
Hemodialysis must be performed in a medical facility, using 4-6 liters of dialysate per session, with blood flow controlled between 200-300 mL/min. The dosage is adjusted based on the patient's weight and waste accumulation, with a target clearance rate (Kt/V) of at least 1.2.
Peritoneal dialysis requires exchanging 1.5-3 liters of dialysate 3-4 times daily. Chronic patients usually undergo long-term treatment, while acute cases may use it for a short period.
Peritoneal dialysis can more evenly remove middle-molecular-weight toxins, while hemodialysis is more effective at clearing large molecules such as β2-microglobulin. Both methods require dietary control 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, necessitating regular monitoring of calcium-phosphorus metabolism.
Risks associated with peritoneal dialysis include peritonitis (annual incidence approximately 10-15%), protein loss, and metabolic acidosis. Close observation of dialysate clarity and body temperature changes is essential. Strict aseptic technique is crucial 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 require treatment adjustments.
Patients must adhere to dietary restrictions, including low potassium and sodium intake, water limitation, 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 removal. For example, iron supplements may need increased frequency due to dialysis-related losses.
Patients undergoing surgery or chemotherapy should have dialysis schedules 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%, while peritoneal dialysis patients have survival rates of about 50-60%. The efficacy varies depending on patient age and complication management.
Clinical studies confirm that dialysis effectively reduces serum creatinine and 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 (HHD) offers another option but requires trained personnel for operation and maintenance.
For patients with acute kidney injury, continuous venovenous hemofiltration (CVVH) is a common short-term therapy in intensive care units.
Before hemodialysis, patients need to undergo 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 are fever or redness and swelling at the fistula site.
How to respond if blood pressure suddenly drops during dialysis?Hypotension is a common side effect. If dizziness or cold sweat occurs during treatment, notify medical staff immediately to adjust dialysate composition or reduce flow rate. Daily, control water intake, follow medical advice on salt supplementation, and avoid eating sugary foods an hour before treatment to reduce risk.
Can patients perform light exercise after dialysis?Doctors generally recommend avoiding strenuous activity within 30 minutes after dialysis, but gentle exercises like walking are acceptable. The arm with the fistula should avoid lifting heavy objects or measuring blood pressure. Daily self-checks of fistula vibration are advised, and if abnormalities are felt, medical attention should be sought 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. Using boiling and discarding the water method can reduce potassium content. Daily potassium intake should be kept below 2000 mg, with regular monitoring of serum potassium levels.
How do long-term dialysis patients prevent frostbite risk at the fistula site during winter?The fistula site should be protected from prolonged exposure to cold environments. When bathing, water temperature should not exceed 40°C. Wearing specialized insulating sleeves can maintain local blood flow. If skin turns purple or temperature drops significantly, cold and hot stimuli should be stopped immediately, and the medical team should be notified to evaluate thrombosis risk.
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