What kidney disease requires dialysis

There are many types of kidney disease, and kidney disease can recur. Here we mainly talk about under what circumstances dialysis is needed. Nephritis requires about four cycles of dialysis. If the amount and frequency of urination decreases or heart failure occurs, dialysis may be required. In addition, people with diabetes also need dialysis. The early stage of renal failure is uremia, which also requires dialysis.

1. Hypertension: It is mainly caused by water and sodium retention, increased activity of the renin-angiotensin system, and increased excitability of the sympathetic nervous system.

The first step in treatment is to limit water and sodium intake and pay attention to maintaining dry body weight. Blood pressure can be controlled in 75% of patients. If ineffective, antihypertensive drugs can be added, with ACEI and calcium channel blockers being the first choice. 3% to 5% of patients have refractory hypertension, and switching to peritoneal dialysis or hemofiltration may be effective.

2. Left ventricular failure: In addition to hypertension and water and sodium retention, its causes are also related to anemia, acidosis, fistula, electrolyte imbalance, malnutrition, etc. Adequate dialysis dehydration and maintaining dry body weight are the main treatment methods. Other treatments include correcting anemia, controlling blood pressure and conducting nutritional therapy.

3. Coronary artery disease: It is mostly caused by coronary ischemia due to excessive ultrafiltration on the basis of existing coronary atherosclerosis. Controlling high blood pressure and high blood lipids, correcting anemia, maintaining body weight between dialysis sessions and avoiding excessive dehydration can effectively prevent its occurrence. Treatment is the same as for non-dialysis patients. For patients who develop angina pectoris during dialysis, the blood flow should be slowed down, ultrafiltration should be stopped, and oxygen and nitroglycerin should be taken sublingually. Those with hypotension should be given volume expansion. If the treatment is ineffective, hemodialysis should be stopped and further treatment should be given. Those with recurrent episodes can switch to peritoneal dialysis or hemofiltration.

4. Pericarditis: Pericarditis that occurs within 2 weeks after the start of dialysis is called early pericarditis.

It is called delayed pericarditis, and the pathogenesis is not clear. Early pericarditis often presents with symptoms of chest tightness, chest pain and pericardial friction sound, and enhanced dialysis can be effectively treated. Delayed pericarditis is often asymptomatic, with only repeated episodes of hypotension during dialysis. Some patients are responding to enhanced dialysis, while others require switching to peritoneal dialysis.

5. Pulmonary edema: mostly caused by excessive water load. Other causes include congestive heart failure, hypoproteinemia and increased permeability of pulmonary capillaries. Adequate ultrafiltration of water can rapidly improve symptoms. Strictly limiting water intake, adequate dialysis and correcting hypoproteinemia can effectively prevent it.

6. Pleural effusion: mainly exudative. It is mostly caused by heart failure, water and sodium retention, nephrotic syndrome, infection, etc., and some are idiopathic uremic pleural effusions of unknown causes. Treatment should include strengthening dialysis and ultrafiltration, correcting hypoproteinemia, improving general condition, and performing thoracentesis to extract fluid if necessary.

7. Gastrointestinal diseases: including esophagitis, gastritis, gastric ulcer, delayed gastric emptying and gastrointestinal bleeding. It is mostly caused by urea toxin retention damaging the autonomic nervous system causing gastrointestinal motility disorders; abnormal gastrin metabolism leading to increased gastric acid secretion; anemia, malnutrition and other factors that weaken the protective factors of the mucosa. In terms of treatment, enhanced dialysis is often effective, and drugs that promote gastrointestinal motility, gastrointestinal mucosal protectants that do not contain aluminum or magnesium, and antacids can also be used. When there is gastrointestinal bleeding, attention should be paid to the choice of anticoagulation method.