Chronic Renal Failure Replacement Therapy

Written by Wang Fei Long
Nephrology
Updated on August 31, 2024
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Chronic kidney failure is the irreversible loss of nephron units and kidney function caused by the progressive progression of chronic kidney disease, leading to a clinical syndrome characterized by the retention of metabolic products and toxins, disturbances in electrolyte and acid-base balance, and endocrine disorders. Chronic kidney failure often progresses to end-stage kidney disease, and the late stage of chronic kidney failure is called the uremic stage. After entering the uremic stage, renal replacement therapy is often required, with the main methods being hemodialysis, peritoneal dialysis, and kidney transplantation.

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Precursors of renal failure

The kidneys have a very strong compensatory ability. When kidney function is slightly impaired, many people do not have any uncomfortable symptoms and feel everything is normal. However, if one actively seeks out early signs, it is possible to detect precursors to kidney failure. At this time, if one can go to the hospital in time for routine blood tests, urine tests, and kidney function tests, it is possible to determine if there is kidney failure. The most obvious precursor symptom of kidney failure is usually general fatigue, which many people tend to overlook. This is because there are indeed many reasons that can cause fatigue, especially since many people attribute it to fatigue or stress factors. Additionally, many patients with precursors to kidney failure experience edema, particularly the kind that disappears after rest, so it is especially not taken seriously. Another symptom of kidney failure precursors is a significant increase in the frequency of urination at night, which is also often overlooked.

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What are the symptoms of chronic kidney failure?

The symptoms of chronic kidney failure are related to the severity of the condition; the more severe the kidney failure, the more symptoms the patient will have. In the early stages, patients may not feel uncomfortable or show any symptoms. Some patients may experience swelling in the lower limbs and facial area. Others may display clinical signs such as elevated blood pressure and visible blood in the urine. As kidney failure progresses and blood creatinine levels exceed 442 umol/L, patients may experience fatigue, which is due to renal anemia. Some patients may also experience a loss of appetite, nausea, vomiting, and other gastrointestinal symptoms.

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What is best to eat for chronic renal failure?

Patients with chronic renal failure are advised to adopt a low-salt, low-fat, and high-quality protein diet. For those not undergoing dialysis, protein intake should be strictly controlled to 0.6 to 0.8 grams per kilogram of body weight per day. Additionally, patients with stage 3 CKD or above often experience electrolyte disorders, such as hyperkalemia, which can lead to cardiac arrest and arrhythmias. Therefore, it is important to avoid foods high in potassium, such as bananas, oranges, dates, kiwis, and tomatoes. Due to the strict protein intake, hypoproteinemia may occur, and these patients are also prone to hyperphosphatemia. It is recommended to choose foods with a low phosphorus to protein ratio, generally those with a ratio below fifteen. After starting dialysis, the same principles apply, but protein intake can be slightly increased, as some protein is lost during both hemodialysis and peritoneal dialysis. The protein intake can be adjusted to 1.0 to 1.2 grams per kilogram of body weight per day, while still controlling phosphorus and potassium intake.

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early symptoms of chronic renal failure

Patients with chronic kidney failure often do not have any specific discomfort or noticeable symptoms in the early stages. However, some patients may exhibit clinical signs, such as edema, due to the kidneys' reduced ability to excrete water, or hypoproteinemia, which leads to a decrease in plasma colloid osmotic pressure, resulting in edema in the lower limbs or eyelids, and facial swelling. Patients may also experience visible blood in the urine, increased urinary foam, and chronic kidney failure often accompanies high blood pressure. Such patients may also suffer from mild renal anemia, hyperkalemia, and other clinical manifestations.

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Why does chronic renal failure cause vomiting?

Patients with chronic renal failure who experience vomiting generally indicates that their condition has become very severe. Typically, from stage four of chronic kidney disease onwards, a large amount of metabolic waste accumulates in the body, and patients may have severe metabolic acidosis, among other issues. These conditions can cause edema of the gastrointestinal mucosa, and these metabolic wastes can also irritate the gastrointestinal tract, leading to symptoms like nausea, vomiting, and loss of appetite. Of course, besides these reasons, other gastrointestinal diseases such as chronic gastritis, gastric ulcers, and even gastric cancer should also be ruled out.