Long-term hemodialysis complications

Many patients with advanced uremia are long-term hemodialysis, hemodialysis (referred to as hemodialysis) that artificial kidney dialysis, is the most commonly used in the treatment of advanced patients with uremia. What are the long-term hemodialysis complications? Many people are worried about this problem. In recent years, with the continuous improvement of dialysis technology, the patient's life can be extended, and some even extended for more than 20 years. But the resulting complications are more and more, and there have been very rapid, and endanger the patient's life,

1 hemodialysis complications imbalance syndrome

Unbalanced syndrome is one of the most common acute complications. Severe high blood urea nitrogen patients, began to dialysis prone to headache, nausea and vomiting, high blood pressure, convulsions, severe cases may have coma. In order to avoid imbalance syndrome, we take the following measures: (1) preoperative dexamethasone 5mg +5% GS20ml + 10% calcium gluconate 10ml intravenous injection. (2) to master the first dialysis time, generally for the first time 2h, after each time as the case increased by half an hour to 1h. (3) blood pressure every hour, pulse once. (4) using high sodium, bicarbonate dialysis. (5) the occurrence of syndrome can be used 5% GS40ml intravenous injection and the application of sedatives.

2 hemodialysis complications air embolism

Air embolism is a certain amount of air into the blood vessels, these gases and blood mixed with foam body fluid to reach the right heart and pulmonary artery, hinder the blood, can lead to heart failure, serious can lead to death. It has been proven that 6ml of air into the rabbit vein after a few minutes in the rabbit died. Foreign reports, animal experiments with dogs, according to 5ml / kg body weight, into the vein into the air, the dog soon died. The above situation shows that when a lot of air into the vein to form air embolism, can endanger the patient's life. In the hemodialysis process, coupled with the blood pump pressure, improper handling in the course of operation, can cause air embolism. Our hospital has 1 case, accounting for 0.01%, due to rescue timely, did not cause consequences. Lessons learned: (1) in the operation in case of a small amount of gas from the veins, can not panic, allowing patients to the left lateral position, take the head low enough high, so that the air blocking the right ventricle floating up, and leave the embolization , A small amount of air in the blood vessels, will soon be absorbed. (2) close observation of changes in condition, the clinical manifestations of air embolism, embolism because of different parts, different symptoms, such as pulmonary circulation is embolized, then from the venous system of air emboli, with the blood flow through the right heart into the pulmonary artery and its branches were blocked And reflex caused by pulmonary artery and coronary heart artery spasm, leading to acute heart failure, patients with dyspnea, pale skin, tachycardia and hypotension and other clinical manifestations. (3) blood, blood, blood rate should be slowed down. (4) strict inspection of the pipeline connection seal is intact.

3 hemodialysis complications within the pipeline coagulation

Dialysis pipeline coagulation often starts at the vein filter, due to a variety of reasons to make the fiber in the blood and blocked the pores of the filter, so that the blood gradually solidified, severe can be extended to the entire dialysis pipeline.

Coagulation often occurs after dialysis 1h, the performance of venous pressure continued to rise to> 100mmHg, even if the blood pump is still not down, indicating that the vein filter has been blocked blood clots, this time should close the blood pump, block blood flow, replace the vein Filter or all dialysis pipes.

Cause a lot of reasons for coagulation, such as insufficient use of heparin, low blood pressure, blood flow per minute <100ml, then the vein or the dialysis device when the blood stagnation time in the intravenous filter is too long, the filter has a foreign body or dialyzer aging. In addition, intravenous injection of certain drugs, such as promethazine, hypertonic glucose, etc. will also promote blood clotting. Patients with systemic infection, thrombocytosis, blood concentration, drug allergy caused by hypercoagulable state, should be taken seriously. To prevent coagulation in the pipeline, we take the following measures: (1) pay attention to the amount and usage of heparin. We are given at the beginning of dialysis heparin 20mg, after every 1h4mg, intravenous arterial puncture needle must have a certain heparin, flushing the pipeline, the pipeline should have a certain heparin, otherwise the blood leads to the pipeline blood will be sticking to the wall, causing Clotting. (2) to ensure that blood flow at about 200ml per minute. Blood flow should be too low to find the reasons for targeted treatment. (3) for patients with continuous hypercoagulable state, should try to get rid of the reasons, and the amount of heparin doubled, the bleeding tendency of patients with in vitro heparin. (4) strict flushing pipe to ensure smooth screen.

In order to avoid and reduce the complications in dialysis, such as hypotension, imbalance syndrome, convulsions and accidents, air embolism, blood leakage, coagulation occurs, should pay attention to the following links: (1) master dialysis time and dehydration. (2) to protect the dialyzer. (3) to strengthen the management of water treatment devices. (4) the rational use of heparin. (5) properly handle the patient's medication, monitoring out, coagulation status. (6) Strict piping. (7) in the whole process of hemodialysis strict aseptic operation, strict full pipeline closed connection.

Advantages and Disadvantages of Dialysis

Dialysis of a certain amount of solute contained in the liquid on both sides of the semipermeable membrane, and the process of moving from the higher concentration side to the lower concentration side through the semipermeable membrane when the concentration on both sides of the membrane is different. Convection, also known as ultrafiltration, refers to the solute and solvent due to dialysis membrane on both sides of the hydrostatic pressure and osmotic gradient and the process of transmembrane transport. Water enters the other side from the side of the semipermeable membrane. Mainly rely on the role of hydrostatic or osmotic pressure. Water enters the side of the hydrostatic pressure from the side of the hydrostatic pressure, and the osmotic pressure acts on the opposite side of the water.

The role of dialysis: Experts pointed out that because dialysis can be in a short time, the body's creatinine and protein content down, you can extend the patient's life, dialysis can be accumulated in the blood too much toxins and excessive moisture In vitro, and added alkaline to correct acidosis, adjust the electrolyte disorder, replace the excretion of kidney function. At the same time, dialysis treatment of uremia, quick, can the shortest possible time for patients from the scope of life risk.

Dialysis will also have shortcomings, the shortcomings of long-term dialysis will form a dialysis dependent, so that patients can not do without dialysis. And dialysis treatment of uremia increased the difficulty and cost of treatment, post-dialysis complications will increase and serious.

Dialysis is a quickest direct removal of human toxins therapy, the body once the accumulation of toxins will endanger life safety, uremic patients through dialysis can be through the toxins, the physical environment to maintain a basic balance, so that the patient's life will be Maintained.

Causes of high creatinine

Creatinine is caused by the cause of what? Jinan kidney disease hospital experts said: creatinine is a measure of kidney function is an important indicator of the higher creatinine that the greater the degree of damage to the kidneys, kidney detoxification function is lower. Patients with high creatinine tend to think that it is not good to control, in fact, in our clear that creatinine is too high what is the cause of the case, it is possible to completely prevent and control.

What is the cause of high creatinine?

First, life is overworked, excessive consumption of physical, excessive sexual intercourse, energy consumption, can also cause the phenomenon of creatinine is too high.

Second, patients with high blood pressure, long-term high blood pressure, persistent severe proteinuria, the condition failed to get timely control, long illness, over time will be associated with high creatine phenomenon.

Third, the body a lot of sweating, drinking water reduction, increased urine output will lead to blood concentration, increased blood concentration, may lead to elevated creatinine. Therefore, in order to early prevention of creatinine high, normal work and happy life, should cultivate a good living habits, abnormal urine situation, timely consultation with online experts, correctly reflect the disease.

Fourth, the patient taking the body harm relatively large drugs, especially patients with kidney disease taking a relatively large harm to the kidneys, will lead to increased body creatinine.
How does the abuse of drugs lead to elevated creatinine?

Fifth, patients with kidney disease, especially in patients with renal insufficiency, kidney lesions, severe glomerular damage, the role of serum creatinine filtration decreased, will lead to a large number of blood creatinine can not be excreted through the urine, resulting in high creatinine. At present, this is the main cause of high creatinine, must be timely treatment.

Hydronephrosis prevention

1. Prevention:
Drug health hydronephrosis generally can not be cured by drugs, but in order to prevent secondary infection and protection of renal function, in the absence of lifting the treatment of urinary tract obstruction can be used:
① antibacterial drugs: such as erythromycin, cephalosporin and so on.
② traditional Chinese medicine treatment: available detoxification of antimicrobial medicine, such as Bupleurum, Phellodendron, Scutellaria, Plantago and so on.
Diet health ① increase energy intake, but in order to avoid increasing the burden of water and kidney, should not eat too much food rich in protein. Energy intake depends mainly on carbohydrates and fatty foods.
② such as unilateral hydronephrosis, do not limit the amount of water, if bilateral hydronephrosis, renal dysfunction, to limit the daily intake of water.

2. Other Precautions:
Hydronephrosis once complicated by infection, if the obstruction is not timely release, infection is difficult to cure, infection and accelerate the destruction of the kidneys, the formation of a vicious cycle, and even the formation of pus kidney.

 If you still have any doubts, you can feel to contact me by E-mail renal-disease@hotmail.com,or WhatsApp / Phone Number: 008615132830921

our doctor will reply you  with professional suggestion.

The pathogenesis of hydronephrosis

The normal function of the urinary system is the formation, storage and discharge of urine. The formation of urine is composed of glomerular filtration, renal tubular secretion and reabsorption. Under normal circumstances, the renal pelvis contraction, diastolic coordination action, resulting in renal pelvis hydrostatic pressure of about 10cm H2O or so, to ensure the smooth passage of urine.

 When the urinary tract obstruction, the renal pelvic pressure can be increased to 50 ~ 70cm H2O, on the one hand to increase the capsule pressure, on the other hand to reduce the glomerular capillary pressure, the glomerular filtration pressure reduced until the stop. The back pressure of the urine of the renal tubular distal expansion, proximal degeneration, loss of the original secretion and reabsorption function. Due to increased intracranial pressure to the blood vessels pressure, especially the output of the glomerular artery after compression, renal tissue nutrition disorders, renal papillary degeneration atrophy, by the convex concave, renal tubular degeneration and renal thinning, And finally atrophy into fibrous tissue cysts.

Observation of the ureteropelvic junction with optical and electron microscopy, mainly in the wall muscle changes, such as collagen tissue proliferation, deposition and fibrous tissue infiltration, which may be caused by local stenosis and then the main reason for the formation of obstruction. Ureteral contraction of the rhythm, urine retention can also form an obstruction.

This is part of the hydronephrosis in patients with renal pelvis and ureteral connection lumen although smooth but can still lead to obstruction reasons. Renal effusion is not static, but often cycle. In the water after 2 weeks, the renal ureter urine urea was significantly reduced, while the glucose and chloride has increased significantly.

Renal pelvis and re-absorption of the way may be:
① calyx bulb venous reflux; ② renal tubular reflux; ③ interstitial reflux; ④ lymphatic reflux. So acute obstruction if within 5 to 6 weeks to lift the obstruction, renal function can still be restored, which also prompted us to hydronephrosis, especially acute obstruction, can not easily decide the line of renal resection. After the formation of obstruction after the formation of hydronephrosis, depending on the severity of obstruction (obstruction is to continue to develop), renal pelvis adaptability (buffer) and the rate of urine flow, if the relative balance, you can stop the development, Thus stabilizing in the mild hydronephrosis stage.

Hydronephrosis etiology

Hydronephrosis can be divided into primary and secondary two. Primary hydronephrosis, also known as congenital hydronephrosis, spontaneous hydronephrosis, idiopathic hydronephrosis. The most important cause is the obstruction of the ureteropelvic junction, which is often due to the part of the muscle cells by a large number of collagen fibers separated, lost the normal arrangement, can not effectively transmit from the pacing cells of electrical activity, blocking the normal peristalsis The transmission.

Congenital hydronephrosis and more caused by mechanical obstruction, the main reasons are: ① ectopic blood vessels: such as from the lower pole of the vagal vasoconstriction; ② fiber cord; ③ ureteropelvic high insertion; ④ ureteropelvic junction stenosis (Obstruction of ureteropelvic junction, UPJO) and valvular; ⑤ membranous adhesions caused by local ureter tortuosity. Congenital hydronephrosis can also be caused by the cause of power, such as segmental non-dynamic dysfunction.

Secondary hydronephrosis due to other diseases caused by the urinary system, through routine examination can generally find the primary disease, some diseases need to pass a special examination (such as CT, magnetic resonance imaging, etc.) to confirm the diagnosis. These diseases include: ① upper urinary tract obstructive lesions, tumors, polyps, stones, tuberculosis, inflammation, injury, deformity, diverticulum, renal ptosis, etc .; ② upper urinary tract external compression, abdominal, pelvic or retroperitoneal mass , Idiopathic retroperitoneal fibrosis, ectopic blood vessels, pregnancy and menstrual congestion of the ovarian vein compression; ③ lower urinary tract obstructive lesions, benign prostatic hyperplasia, prostate cancer, urethral stricture, vesicoureteral reflux and so on.