How to protect residual renal function in patients with uremia dialysis?

The development of chronic renal failure to the end of the need for renal replacement therapy, kidney transplantation due to kidney stress limited its widely in clinical practice, the use of dialysis (hemodialysis / peritoneal dialysis) is the choice of most patients. Urological patients after dialysis, due to improper disposal, soon no urine, residual renal function soon lost, seriously affecting the quality of life of patients. As everyone knows, uremic patients, although dialysis treatment, but the residual renal function is very valuable to patients. Evaluation of residual renal function in many ways, the simplest is the patient's urine output.

There is some misunderstanding in dialysis patients and even non-dialysis medical staff. Urine output gradually reduced until the anuria or oliguria is uremic dialysis patients in the inevitable trend, so many people do not pay attention to dialysis patients with urine, that anyway, dialysis, urine output is to reduce the amount of urine does not matter. Clinical experience tells us that in the face of different dialysis patients, dialysis after partial urine output in patients with their survival status and quality of life than non-urinary patients to be high. So how to protect the patient's residual renal function is particularly important, the following measures help to protect patients with residual renal function:
1. To avoid excessive ultrafiltration dehydration. Uremia hemodialysis patients due to excessive toxins, coupled with salt intake is not controlled, such as dialysis is not sufficient, due to hypertonic environment, dry mouth is very obvious, if not limit the intake of water, resulting in dialysis interval weight gain too much Fast, in order to maintain dry weight, often in the dialysis unit time ultrafiltration dehydration too much, too fast, the body too late to compensate, resulting in a sharp reduction in renal perfusion, urine output soon reduced or even anuria, which is leading to residual renal function One of the most important factors of loss. In the face of such circumstances, to strictly control the dry weight, dialysis interval weight growth can not be too much, it is best not to dry weight of 5%, for the elderly and weight loss in patients with dry weight to control more stringent. Similarly, for patients with peritoneal dialysis, and sometimes patients with obvious edema, in order to increase the amount of ultrafiltration, frequent use of high concentrations of peritoneal dialysis, patients will also accelerate the residual renal function loss in patients with dialysis, dialysis patients should avoid using 2.5 % Peritoneal dialysis solution, for use, need to weigh the pros and cons.
2. Avoid nephrotoxic drug use. Although patients with uremia into dialysis, but most patients still have some residual renal function, in clinical work, or to try to avoid the application of nephrotoxic drugs. Such as antipyretic analgesics, aminoglycoside antibiotics and so on in the clinical should try to avoid use, because the use of nephrotoxic drugs will reduce the glomerular filtration rate, resulting in residual renal function soon lost.
3. Application of renal protective drugs. Whether it is hemodialysis patients or peritoneal dialysis patients, in close monitoring of side effects under the premise of the patient to protect the residual renal function, it is recommended to use angiotensin converting enzyme inhibitors or angiotensin II receptor antagonists, in addition to play a blood pressure, Reversing ventricular remodeling, but also help to protect patients with residual renal function.
4. Appropriate use of diuretics. In addition to the above methods, but also consider the application of climbing diuretics to protect patients with residual renal function. This is particularly important for patients with peritoneal dialysis, peritoneal dialysis is an important advantage due to its hemodynamic stability, it has the advantage of protecting the residual renal function, peritoneal dialysis patients with urine output, it is recommended to take conventional diuretics, of course Note the side effects of diuretics.
Dialysis treatment is one of the important treatment of uremic patients, such as to ensure adequate dialysis under the premise of protecting residual kidney function, delay the loss of residual renal function, to maintain part of the urine output, will undoubtedly improve the quality of life, improve the long-term Prognosis.