How long can uremia live?
Many patients feel that uremia means that there is no cure. In fact, don't be defeated by the disease before treatment.
There are three main treatments for uremia: hemodialysis, peritoneal dialysis and kidney transplantation. We can choose different ways according to different situations.
For example, patients with large residual urine can choose peritoneal dialysis first, and then switch to hemodialysis after peritoneal failure dialysis is insufficient, or choose hemodialysis first and then switch to peritoneal dialysis after long-term dialysis. If there is a suitable kidney source, kidney transplantation is also feasible.
How long you can live in the early stage of uremia depends on what kind of treatment is adopted, whether the treatment is proper or not, and whether the treatment is timely.
Therefore, how long you can live in the late stage of uremia depends on whether the treatment is proper and how long you can live without dialysis.
Patients with advanced renal failure should be treated as soon as possible to improve their quality of life and ensure their survival.
The most important thing is to look at the degree of the disease, such as whether there is still urine excretion, the severity of complications, whether the kidney is completely fibrotic and many other reasons.
If there is still a certain amount of urine, it generally means that the kidney still has certain functions. If the residual renal function is well protected and the nephron function returns to normal, it is possible to get rid of dialysis and live a long-term healthy life.
If there is no urine for a long time, it generally means that the kidney has been completely necrotic or completely fibrotic. The hope of conservative treatment is basically zero, and people can only rely on dialysis to maintain their lives. Some people can live on dialysis for many years, but they have to bear huge dialysis costs.
Generally speaking, if there are conservative treatment conditions, early treatment can effectively prolong life and even live healthily for a long time.
Effective methods to relieve uremia
Must be actively treated, uremia is a fatal disease, but it is not an incurable disease. For cases without inducing factors, dialysis can be considered when renal function is irreversible. Dialysis treatment includes oral, peritoneal and hemodialysis (artificial kidney); Oral dialysis treatment is only suitable for patients with mild uremia. In recent years, due to the wide application of dialysis therapy, many patients with advanced uremia have survived for more than 5 years and maintained a certain labor force. At present, dialysis therapy and 5C Shen Kang system are common treatment methods for uremia patients.
In addition, chemicals containing cadmium, chloroform, ethylene glycol and tetrachloroethylene that are harmful to kidneys, articles and the environment should be avoided. They are usually found in pesticides, automobile exhaust, paints, building and household cleaners.
Treatment of uremia
When chronic renal insufficiency progresses to uremia, renal replacement therapy is needed.
Often some patients have entered uremia stage, but they have been dragging their feet and are unwilling to receive dialysis treatment, always worrying about the side effects and costs of dialysis. Many patients also hope that Chinese medicine can cure them? Cure? Uremia, get rid of dialysis. In fact, dialysis is to replace the kidney. When the patient enters uremia, the patient's kidney should be damaged by more than 90%. If the substitution treatment is delayed at this time, the toxin will remain in the body, and it will also bring irreversible damage to other organs of the body, such as the heart, digestive system, bones and blood system. Uremia is a disease that cannot be cured by drug treatment. There is no such thing as curing uremia. A panacea? . Therefore, uremia patients should not hesitate to take renal replacement therapy in time, that is, dialysis treatment.
For uremic patients whose condition is relatively stable
The condition of these patients is relatively stable. Although renal replacement therapy needs to be started as soon as possible, there is no indication of emergency dialysis. Such patients should actively prepare for dialysis while taking medicine and controlling diet. For example, medical staff should educate patients about relevant contents before dialysis, so that patients can fully understand the necessity and limitations of renal replacement therapy, and choose the appropriate dialysis method (hemodialysis or peritoneal dialysis) according to their own conditions, family environment, work situation and economic situation; Patients who plan to undergo hemodialysis need to undergo ostomy 1 ~ 3 months in advance and contact the hemodialysis center for long-term dialysis treatment. For patients preparing for peritoneal dialysis, peritoneal dialysis tubes should be inserted 2 ~ 4 weeks in advance.
Uremic emergency
Common uremic emergencies include:
The ability of renal potassium excretion decreases in hyperkalemia uremia, and hyperkalemia is easy to occur at this time; In particular, hyperkalemia is more likely to occur when potassium intake is excessive, acidosis, infection, trauma and gastrointestinal bleeding. Severe hyperkalemia (serum potassium >; 6.5mmol/l) may lead to cardiac arrest, which is life-threatening, and should be rescued in time: ① Calcium is used to resist the toxicity of high potassium to myocardium, and 10% calcium gluconate 10 ~ 20 ml is usually added with the same amount of hypertonic glucose, and it is slowly and statically pushed for at least 5 minutes. If the arrhythmia does not improve after 5 minutes of injection or recurs soon after effective, it can be injected again; Sodium lactate or sodium bicarbonate can promote potassium ions to enter cells, antagonize the inhibitory effect of potassium on the heart and increase the excretion of potassium in urine; ③ Combined application of glucose and insulin (4g glucose: 1U insulin) can promote the transfer of potassium into cells; ④ Oral or injection of diuretics (furosemide, torasemide, etc.). ) promote potassium excretion in the kidneys; ⑤ Oral cation exchange resin can promote intestinal potassium excretion; ⑥ Hyperkalemia is very serious (> 6.5mmol/l). When the above treatment effect is not good, hemodialysis can be used to reduce blood potassium. In uremia patients complicated with heart failure and pulmonary edema, the function of regulating water and sodium balance of kidney is decreased or even lost, and the urine volume is reduced, which is easy to form capacity overload. In severe cases, heart failure and pulmonary edema occur, which is life-threatening. Preventive measures include: ① controlling the amount of drinking water so that the inflow of water is less than the outflow of water, and giving diuretics when necessary; ② Hemodialysis, ultrafiltration and dehydration; ③ Cardiotonic therapy, catheter dilation and other treatments. Blood pH value of metabolic acidosis
Hemodialysis and peritoneal dialysis
Hemodialysis: the patient's blood is introduced into the dialyzer through the vascular access, and the material exchange between the dialyzer and the dialysate is carried out in the dialyzer, and then the purified blood is returned to the body, so as to discharge waste and correct the electrolyte and acid-base balance disorder. Many patients can survive 10 ~ 20 years if they insist on reasonable dialysis for a long time.
Hemodialysis needs to go to the hospital two or three times a week for about 4 hours each time. Its advantage is that there is less waste accumulated in the body after hemodialysis, and it has a fixed time to go back to the hospital for treatment every week. If the condition changes, it can be treated in time. Dialysis is operated by professional medical staff, and you don't have to do it yourself.
The disadvantages are also obvious: needles need to be inserted every time; Anemia is more serious; Blood pressure will be affected before and after dialysis, which is not good for patients with cardiovascular disease and diabetes. Need to strictly control diet; It is easy to feel uncomfortable before dialysis; Cannot change the dialysis time at will; The risk of infection with hepatitis B and C is greatly increased.
Peritoneal dialysis: What do you mean? Abdominal dialysate? Through a special liquid? Abdominal dialysis tube? Pour it into the abdominal cavity. At this time, one side of the peritoneum is blood containing metabolic waste and excess water, and the other side is dry peritoneal dialysate, so that the metabolic waste and excess water in the blood will run into the peritoneal dialysate through the peritoneum. After keeping it for 3-4 hours (it can be kept for 8- 10 hour at night), release these peritoneal dialysate containing waste from the abdominal cavity, and then inject new peritoneal dialysate. In this way, it can be replaced 3-4 times a day, and the toxins and excess water in the body can be continuously discharged. After education and training, patients and their families have mastered the operation of peritoneal dialysis and can carry out peritoneal dialysis at home by themselves. If you use an automatic peritoneal dialysis machine, you can have dialysis in your sleep every night and work and study normally during the day.
Advantages of peritoneal dialysis:
⑴ Protection of residual renal function is better than hemodialysis: Peritoneal dialysis is the treatment scheme closest to physiological state, and there is no mutation in hemodynamics, body fluid volume and biochemistry during peritoneal dialysis, thus reducing dialysis complications caused by unstable internal environment, such as cardiovascular diseases, hypertension, hypotension and arrhythmia. It will not cause renal ischemia during the treatment, which is beneficial to protect residual renal function.
⑵ Wide scope of application: Peritoneal dialysis has good cardiovascular stability and is the first choice for patients with severe cardiovascular and cerebrovascular diseases, diabetes and the elderly; Abdominal dialysis has less dietary restrictions, better nutritional status of patients, little impact on children's growth and development, and avoids the pain of hemodialysis puncture; Abdominal dialysis does not need arteriovenous fistula, which avoids the occlusion of arteriovenous fistula caused by peripheral vascular disease in diabetic patients.
⑶ High dialysis efficiency: For medium molecular toxin substances,? The removal effect of microglobulin and phosphorus is better. Therefore, peritoneal dialysis can improve uremic symptoms, anemia and neuropathy more than hemodialysis.
⑷ The chances of being infected with viral hepatitis B and C are less.
5] The degree of dialysis osteopathy in long-term dialysis is also better than that in hemodialysis.
[6] Dialysis can be carried out at home, without going to the hospital, without affecting work, study and travel, with low treatment cost and high quality of life.
Disadvantages of peritoneal dialysis: Peritoneal dialysis requires the insertion of peritoneal dialysis tube in abdominal cavity, and there are frequent operations such as changing peritoneal dialysate during dialysis. If patients or their families do not strictly master aseptic operation, infection will easily occur, leading to peritonitis. However, with the improvement of peritoneal dialysis equipment, the strengthening of education and training for patients by peritoneal dialysis specialists and nurses, and the improvement of living and sanitary conditions, the incidence of peritoneal dialysis infection has been greatly reduced.
Peritoneal dialysis has been used to maintain the life of uremic patients for more than 30 years. At present, in Hong Kong and some European countries, 80% uremia patients live, work and study under peritoneal dialysis treatment.
However, hemodialysis and peritoneal dialysis can only replace the kidney's function of removing metabolic waste and maintaining the balance of water, electrolyte and acid-base, but can't replace another important function of the kidney, namely endocrine function, such as producing EPO and active vitamin D3. Therefore, patients with maintenance hemodialysis or peritoneal dialysis still need to be treated with EPO, calcitriol and other drugs according to their condition. Not what some patients think? Do dialysis so you don't have to take medicine? .
Kidney transplantation is the most reasonable and effective treatment for uremia patients, but due to the lack of donors, kidney transplantation can not play its due therapeutic role. At present, there are only more than 5,000 renal transplant recipients in China every year, and only 1 of every 150 waiting patients may get a kidney transplant. The shortage of donors has become a bottleneck restricting organ transplantation. Therefore, most uremic patients need long-term maintenance hemodialysis or peritoneal dialysis treatment. According to institutional statistics, there are about 654.38+million dialysis patients in China, of which about 90% are hemodialysis patients and only 654.38+00% are peritoneal dialysis patients.