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What are indications and contradictions of hemodialysis?
Before heading towards the topic, think of the two questions: what is
hemodialysis? How it functions to kidney failure patients? Hemodialysis is an
artificial way for eliminating excess toxins and relieving symptoms of kidney
failure. Normally, kidneys perform several main functions for human body:
1)filtrate bloodstream, remove metabolic toxins and prevent nutrients from
escaping; 2) secrete various important hormones, such as renins, EPO and
prostaglandin, etc; 3) maintain balances of electrolytes and acid-base. In
kidney failure patients, a large quantity of healthy functioning renal intrinsic
cells are impaired or necrotic, the patients will present various clinical
manifestations. Dialysis functions to remove toxins and correct part of
electrolyte disorders. It doesn’t improve kidneys, but has shown significance in
reducing some life-threatening complications of kidney failure.
What are indications of hemodialysis?
Chronic kidney failure-indications of hemodialysis
For chronic kidney failure, it is generally accepted that the patient should
start dialysis when serum creatinine increases above 707mmol/l or blood urea
nitrogen level exceeds 30mmol/l. However, if toxins have not reached such high
levels, but the patient begins to experience severe nausea, vomiting, swelling,
or incorrected acidosis, hyperparathyroidism and heart failure, dialysis should
be started at once. On the other hand, if creatinine and BUN both exceed the two
levels and the patient doesn’t have severe discomfort, dialysis treatment is not
a necessity.
Whether dialysis should be started is also determined by blood electrolyte
levels. Blood potassium>6.5mmol/l is an indicator for initiating dialysis
immediately. Diabetics seem to start dialysis earlier than others due to that
their complications arrive more earlier and complex than others.
Acute kidney failure-indications of hemodialysis
1) If blood urea nitrogen (BUN)>35.7 mmol/l or BUN increases by over
10.7mmol/l each day, the patient should start dialysis immediately.
2) If one has been making no urine or urine output<400ml over two days,
and any one of the following is combined, dialysis should also be started:
﹡Blood urea nitrogen>35.7mmol/l(100mg/dl)
﹡Serum creatinine>884mmol/l(10mg/dl)
﹡Blood potassium>6.5mmol/l
﹡Blood hemoglobin HCO3-<15mmol/l
﹡CO2 combination<13.4mmol/l
﹡Obvious swelling, vomiting, nausea, sleeplessness, disturbance of
consciousness and pulmonary edema
﹡Free hemoglobin>12.4mmol/l
What are contradictions of hemodialysis?
Clinically, there are no absolute contradictions of hemodialysis, but to
decrease risks, hemodialysis is not suggested is the following conditions are
not controlled well:
﹡Severe bleeding/hemorrhage or anemia
﹡Stroke or systolic pressure less than 80mmHg
﹡ Serious cardiovascular diseases, such as obvious heart hypertrophy, heart
dysfunction, arrhythmia, high blood pressure and cerebral accident
﹡Uncontrollable infections, Sepsis or those with blood-borne infectious
diseases
﹡Those with malignant tumors
﹡Poorly controlled Diabetes
﹡Within three days after a major surgery
Clinically, whether dialysis can be started or not should be based on your
own specific condition. Nephrologists will provide advice based on your kidney
condition, blood electrolytes, complication severity, etc. If you need further
information, feel free to ask experts online for free.
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