Does chronic renal failure require dialysis?

Written by Zhou Qi
Nephrology
Updated on September 20, 2024
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Not all cases of chronic renal failure require dialysis. It is only considered when chronic renal failure progresses to an advanced stage, causing severe consequences, and the kidneys are unable to maintain normal body functions, leading to many complications. Generally, when chronic renal failure progresses to its final stage, i.e., uremia, the kidney function is left with about 10% capacity. The body then experiences a disruption in its internal environment, including the accumulation of a large amount of metabolic waste, serious electrolyte disorders, and severe metabolic acidosis. It is at this point that dialysis is considered. In the early stages of chronic renal failure, dialysis is not necessary.

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Chronic Renal Failure Replacement Therapy

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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Symptoms of chronic renal failure

The clinical symptoms of chronic renal failure vary at different stages. In the compensatory and early decompensatory stages of chronic renal failure, patients may experience no symptoms or only mild discomforts such as fatigue, back pain, and increased nocturia, while a few may suffer from reduced appetite, metabolic acidosis, and mild anemia. The main clinical symptoms include disorders of water, electrolyte, and acid-base balance, presenting metabolic acidosis, sodium retention or hypovolemia, or hyponatremia, along with hyperkalemia. Moreover, there are significant manifestations of excess phosphorus and calcium deficiency. Patients may also experience disruptions in the metabolism of proteins, carbohydrates, fats, and vitamins. Cardiovascular symptoms mainly include hypertension, left ventricular hypertrophy, heart failure, and uremic cardiomyopathy. Gastrointestinal symptoms can manifest as loss of appetite, nausea, and vomiting. Hematological manifestations may include renal anemia and a tendency to bleed.

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What medicine is used for chronic renal failure?

The treatment of chronic renal failure primarily requires identifying the cause and treating it accordingly. Chronic renal failure refers to the state in which various diseases damage the kidneys, leading to the destruction of kidney tissue and resulting in the kidneys' inability to adequately excrete metabolic waste, causing an accumulation of such wastes in the body. There are no medications that can directly affect the kidneys, regenerate kidney tissue, and restore kidney function. Currently, medicine cannot achieve this, and there are no specific drugs for the treatment. Therefore, the treatment of chronic renal failure focuses on treating the primary disease to slow the progression of renal failure. For example, chronic renal failure caused by diabetes necessitates the use of insulin to control blood sugar, while patients with hypertension need to use antihypertensive drugs.

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Chronic renal failure anemia treatment

Patients with chronic renal failure generally have anemia combined with stage three or above of chronic kidney disease (CKD). When the hemoglobin falls below 100 grams per liter, it is necessary to start treatment to correct anemia. At this point, relevant lab tests should be conducted to check for abnormalities in folate, vitamin B12, ferritin, and serum iron levels, and specific treatments should be administered accordingly. Treatments generally include iron supplements, erythropoiesis-stimulating agents, folate, and vitamin B12 to help correct anemia.

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Can chronic renal failure become pregnant?

Although patients with renal failure are not absolutely unable to become pregnant, pregnancy is ultimately a burden on the kidneys. Pregnant patients with renal failure may experience further deterioration of kidney function and may face numerous complications during pregnancy, such as heart failure, severe anemia, etc., which may pose some risks. However, there are still very rare case reports, including successful pregnancies in patients on dialysis for uremia, but the probability of this is extremely small, and the risks involved are too great. Generally speaking, it is not recommended for female patients with chronic renal failure to become pregnant.