What to do with renal failure and anemia

The kidney is an important organ in our human body, and most of the body's metabolism is assisted by the kidney. But the problem of kidney failure has been bothering many people. Some patients with renal failure also have anemia. Anemia is caused by renal ischemia and will cause many symptoms, such as difficulty breathing, fatigue, drowsiness, dizziness, etc. If anemia occurs, go to the hospital for examination and treatment in time. Let’s take a look at what to do with renal failure and anemia?

1. The occurrence and severity of complications of chronic renal failure are related to the level of glomerular filtration rate. The degree of anemia can vary greatly between individuals, but the degree of anemia in each individual is relatively stable. The anemia of patients with polycystic kidney disease is milder than that caused by renal failure of other causes. The hematocrit of patients with renal failure accompanied by hypertension is higher than that of patients with normal blood pressure, which may be due to renal ischemia caused by hypertension. Anemia affects the supply and utilization of tissue oxygen and the increase in cardiac output, and often manifests as fatigue, dyspnea, leading to cardiac enlargement, ventricular hypertrophy, angina pectoris, heart failure, cerebral insufficiency, decreased cognitive function, immune function damage and a series of pathological and physiological phenomena, affecting the patient's prognosis and quality of life.

1. Iron and folic acid

Since patients with chronic renal failure often suffer from iron malabsorption, gastrointestinal blood loss and chronic blood loss related to dialysis, the erythropoiesis induced by anemia in chronic renal failure will quickly consume the iron stored in the body, resulting in iron deficiency. Commonly used oral iron supplements include ferrous sulfate, ferrous succinate and polysaccharide complexes, and intravenous iron preparations include iron dextran, iron gluconate and iron sucrose. Routine use of low-dose intravenous iron can better prevent iron deficiency and promote erythropoiesis than oral iron, especially for patients undergoing hemodialysis.

2. Blood transfusion therapy

Math can only provide short-term relief for patients with anemia and is currently believed to be only suitable for patients with severe anemia and in urgent need of a kidney transplant. Repeated blood transfusions can also lead to iron overload, viral infection, and histocompatibility leukocyte antigen immunity.

3. Dialysis treatment

Dialysis can significantly improve the degree of anemia in patients with chronic renal failure. Studies have shown that dialysis can fully remove small molecule metabolites and maintain low urea nitrogen levels. It can also increase the life span of red blood cells, improve coagulation mechanism and nutritional status.

4. Kidney transplant

Kidney transplantation is the most effective measure to treat chronic renal failure. Serum EPO levels can double within 7 days after kidney transplantation and then continue to increase until anemia is corrected. Reached normal range within 4 months. 2. Inspection 1. Laboratory examination

(1) Routine blood examination: The reticulocyte count is decreased, but not proportional to the degree of anemia. Hematocrit decreases, red blood cell count decreases, and hemoglobin (Hb) decreases.

(2) Peripheral blood smear: fragmented red blood cells are occasionally seen, but most are normal.

(3) Renal function test: serum creatinine increased and endogenous creatinine clearance (CCr) decreased.

(4) Iron metabolism examination: decreased serum ferritin (<12 μg/L), decreased serum iron (<8.95 μmol/L), and decreased transferrin saturation (<15%) indicate iron deficiency.

2. Electroencephalogram

It can be seen that the patient's cognitive function is impaired. 3. Diagnosis: Chinese adult males are diagnosed with anemia when their hemoglobin level is less than 120g/L, non-pregnant females less than 110g/L, and pregnant females less than 100g/L. If the glomerular filtration rate is <30 ml/min or the blood creatinine is >300 μmol/L, anemia caused by renal failure should be considered, but anemia caused by other reasons should be excluded. 4. Differential diagnosis of renal anemia requires differentiation from anemia caused by other reasons. If the degree of anemia is disproportionate to the degree of kidney damage, other causes should be considered. Blood smear, serum erythropoietin, serum iron, serum transferrin saturation tests, etc. can assist in the differentiation. If the erythropoietin level is elevated, it is almost certain that there is anemia caused by other reasons. It should be noted that renal anemia may also be combined with other types of anemia (such as iron deficiency anemia).