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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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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Principles of Treatment for Chronic Renal Failure

The principles of treatment for chronic renal failure include early-stage non-dialysis conservative treatment as well as end-stage renal replacement therapy. Non-dialysis conservative treatment includes delaying the progression of kidney damage, which requires treating the primary disease, implementing nutritional support, and controlling factors that accelerate kidney disease progression, such as controlling high blood pressure, proteinuria, and hyperlipidemia. Additionally, it is necessary to eliminate metabolic waste from the body, and maintain the body's water, electrolyte, and acid-base balance. Renal replacement therapy includes hemodialysis, peritoneal dialysis, and kidney transplant therapy.

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Causes of Anemia in Chronic Renal Failure

The causes of anemia in chronic renal failure, also known as renal anemia, occur in chronic kidney disease and are related to chronic renal failure. There are multiple reasons for this anemia, such as the lack of raw materials for red blood cell production caused by chronic renal failure, including deficiencies in iron, folic acid, and vitamin B1, shortened lifespan of red blood cells, and blood loss including non-gastrointestinal blood loss. Moreover, uremic toxins including parathyroid hormone can suppress the production of red blood cells in the bone marrow. However, the primary cause is the decreased production of erythropoietin by the kidneys during chronic renal failure.

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Symptoms of Chronic Kidney Failure

The clinical symptoms of chronic renal failure mainly include symptoms related to disturbances in electrolyte and acid-base balance, as well as symptoms of metabolic disorders of proteins, carbohydrates, fats, and vitamins. There are also manifestations in various organ systems, including the cardiovascular system, respiratory system, gastrointestinal tract, hematologic system, neuromuscular system, endocrine system, and bone lesions. Metabolic acidosis is common; patients may also exhibit water and sodium retention or hypovolemia and hyponatremia. Potassium metabolism disorders are often characterized by hyperkalemia, while disturbances in phosphorus and calcium metabolism are mainly manifested as hyperphosphatemia and calcium deficiency. Patients may also show cardiovascular manifestations, primarily hypertension, left ventricular hypertrophy, heart failure, and uremic cardiomyopathy. Gastrointestinal symptoms in patients may include loss of appetite, nausea, and vomiting. Additionally, renal anemia and a tendency to bleed are common, and skeletal changes are quite frequent, leading to malnutrition of bones, osteomalacia, and osteoporosis.

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Can chronic renal failure be cured?

Chronic kidney failure is irreversible and incurable, with no possibility of kidney function recovery. There are many causes of chronic kidney failure, commonly including diabetic nephropathy, hypertensive nephropathy, chronic nephritis, polycystic kidney disease, etc. These causes affect the kidneys over the long term, resulting in extensive damage to kidney tissues. Since kidney tissues cannot regenerate, chronic kidney failure is incurable and irreversible. Patients with chronic kidney failure still require treatment to control the underlying causes leading to the condition, aiming to slow down the progression of the disease as much as possible, prolong the patient’s life, and ensure the quality of life. This is the primary goal of treatment.