Dialysis is a medical technique used to replace kidney function, primarily for patients with severe renal failure who cannot filter waste products normally. 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 adherence and strict medical management. Its applications include end-stage chronic kidney disease and acute kidney injury, serving as an essential supportive therapy before and after kidney transplantation.
Hemodialysis involves guiding blood outside the body through a dialysis machine, where exchange of substances occurs across a semi-permeable membrane with dialysis fluid, removing waste products such as urea and creatinine. This process is typically performed 2-3 times per 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 it themselves but must strictly adhere to sterile procedures.
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 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 cases, Continuous Venovenous Hemofiltration (CVVH) may be used for more gentle toxin removal.
Dialysis effectively delays the progression of uremia. Studies show that regular treatment can increase the 5-year survival rate of end-stage renal disease patients to 60-70%. Hemodialysis rapidly clears large-molecule toxins, while peritoneal dialysis provides continuous filtration, resulting in more stable blood pressure control.
Common immediate side effects in hemodialysis include Dialysis Disequilibrium Syndrome, presenting as dizziness and nausea, with severe cases possibly leading to seizures. Hypotension occurs in 30-40% during initial treatment, often related to excessive ultrafiltration.
Long-term risks include arteriovenous fistula infections, cardiovascular sclerosis, and malnutrition. Peritoneal dialysis patients have an annual infection rate of about 20%, which may lead to peritonitis or fistula blockage, requiring close monitoring of dialysis fluid changes.
Contraindications include uncontrolled severe bleeding tendencies, unhealed vascular access infections, and cardiac tamponade symptoms. Patients need to monitor body weight and blood pressure daily, strictly control sodium intake (<2000 mg/day) to prevent fluid overload.
Anticoagulation therapy requires dose adjustment of heparin, with ACT monitoring during dialysis. Patients with severe hypovolemia or shock should suspend treatment and address primary symptoms first.
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.
Before surgery, dialysis frequency may need adjustment to ensure preoperative nitrogen clearance targets. Potassium-containing medications require enhanced serum potassium monitoring, as fluctuations may occur between dialysis sessions.
Large randomized controlled trials show that regular hemodialysis can extend the median survival of end-stage renal disease patients to 5-10 years. Peritoneal dialysis is superior in blood pressure control but carries a higher risk of protein-energy malnutrition.
The 2020 Cochrane review indicates that thrice-weekly hemodialysis can reduce serum creatinine by 60%, but phosphate binders are needed to control serum phosphate. The treatment efficacy should be evaluated alongside kidney transplantation prospects, with patients awaiting transplantation continuing dialysis support during the waiting period.
Kidney transplantation is the only curative option but requires immunosuppressants and donor matching. Continuous Venovenous Hemofiltration (CVVH) is suitable for acute kidney injury, providing more stable toxin removal.
Home peritoneal dialysis can replace traditional hemodialysis but requires patient self-care capability. 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 placement (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 supplementing vitamin B1 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 porridge, fruits, etc., to prevent fluid overload.
What are the differences between home dialysis and hospital treatment?Home peritoneal dialysis requires training for patients or family members to perform self-care, offering flexibility but requiring strict sterile procedures. Hemodialysis requires visiting a medical facility three times a week, each session about 4 hours. The doctor will recommend the most suitable treatment mode based on vascular condition, lifestyle, and self-management ability.
How can dialysis-related infections be prevented and vascular access lifespan extended?Check daily for redness, swelling, fever, or lumps around the vascular fistula, avoid tight clothing that compresses the access. After treatment, apply pressure at the needle puncture site for 15-30 minutes to stop bleeding, and regularly evaluate fistula blood flow rate. If occlusion or infection occurs, surgical repair or replacement may be necessary.
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