June 26, 2022

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How to figure when to perform dialysis based on uremia indicators?

How to figure when to perform dialysis based on uremia indicators?

 

How to figure when to perform dialysis based on uremia indicators? There are indicators to figure uremia! So, what are the indicators for when to dialysis?

 

Various chronic kidney diseases may progress gradually, and may become uremia one day.

Many people with kidney disease are afraid to talk about uremia, but they cannot avoid it absolutely. Various chronic kidney diseases may progress gradually, and may become uremia one day. Therefore, uremia is not an independent disease, but a clinical syndrome shared by various end-stage renal diseases.

It is a series of clinical manifestations that appear when chronic renal insufficiency enters the terminal stage or the late stage of renal function is almost completely lost. Composed of the syndrome. This process is usually gradual and irreversible.

In the past, the diagnosis of uremia was based on the increase of blood creatinine in patients with chronic kidney disease to more than 707μmol/L, as well as other related evidences. When the serum creatinine of patients with chronic renal failure rises to 707μmol/L, it is diagnosed as the uremic stage of chronic renal failure, which is often referred to as “uremia”.

Nowadays, more diagnoses are made after chronic kidney disease (CKD) staging, which is CKD 1-5, that is, when chronic kidney disease develops to the end stage, that is, CKD 5 can be diagnosed as uremia.

So, how did CKD Phase 5 come about? Here we have to mention the glomerular filtration rate (GFR), that is, by estimating or detecting the glomerular filtration rate, the staged diagnosis of chronic kidney disease can be made, as shown below (GFR is Glomerular filtration rate):

  • Glomerular filtration rate ≥90ml/min, namely CKD stage 1
  • GFR is between 60-90ml/min, that is, CKD stage 2
  • GFR is between 30-60ml/min, namely CKD stage 3
  • GFR is between 15-30ml/min, namely CKD stage 4
  • GFR<15ml/min, namely CKD stage 5 (uremia)


From the above description, we can draw the conclusion that there are indicators for judging uremia, which are related to the numbers 707, 15, and 5, which are expressed as blood creatinine (SCr) greater than 707 μmol/L and glomerular filtration The failure rate (GFR) is less than 15ml/min and progress to chronic kidney disease (CKD) stage 5, etc. Therefore, it is not difficult to diagnose uremia, and it can be judged based on these indicators.

 

Then, some people will have questions: Is there an indicator for uremic when dialysis is also available? If so, what are the indicators?

The earlier view was this: When a kidney disease patient progresses to stage 5 uremia of chronic kidney disease, he should receive renal replacement therapy such as dialysis or kidney transplantation. It is believed that late dialysis has more complications than early dialysis. The prognosis is also worse.

Therefore, it is believed that the uremia index is the dialysis index, that is, when the glomerular filtration rate of patients with chronic kidney disease drops to CDK stage 5 of 15ml/min, it is the dialysis index and should receive dialysis treatment.


However, more research data and clinical observations have found that compared with early dialysis and late dialysis, there is no significant difference in the main complications and complications (infection and cardiovascular and cerebrovascular diseases), mortality and survival time of patients. That is, late dialysis is not worse. However, in terms of quality of life, early dialysis is significantly worse than late dialysis, that is, in terms of quality of life, late dialysis patients with uremia are better.

That is to say, even if the glomerular filtration rate of chronic kidney disease drops below 15ml/min, as long as the patient has no special abnormalities, the internal environment is relatively stable, and the nutritional status is not very bad, that is, the heart function is fair and no Severe hyperkalemia and hyperphosphatemia, no metabolic acidosis that is difficult to correct, no severe malnutrition, etc., can still continue to cooperate with nephrologists to give standardized treatment and scientific management, and may not receive dialysis temporarily.


Some people say that the index of uremic dialysis is when the glomerular filtration of patients with chronic kidney disease drops to 5-10ml/min. In fact, this is not completely regarded as an index for dialysis. It can only be said that when GFR drops to 5-10ml/min. At 10ml/min, dialysis may be needed, or the distance to dialysis is already very close. At this time, it is still necessary to make a comprehensive judgment based on the patient’s condition.

 

 

Conclusion

Diagnosis of uremia can be judged based on relevant indicators. However, there is no fixed indicator of when uremic patients receive dialysis.

It does not mean that patients with chronic kidney disease (CKD) should receive dialysis when their glomerular filtration rate (GFR) drops below 15ml/min in CKD stage 5, nor does it mean that patients with chronic kidney disease whose GFR drops to 5- Dialysis is necessary at 10ml/min. Instead, the nephrologist and the treated nephrologist should form a “management alliance” to maximize the non-dialysis time, so as to extend the life of the patient and improve the quality of life.

 

 

 

(source:internet, reference only)


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