Technology makes hemodialysis patient survival significantly prolonged with chronic renal failure, however, is not entirely hemodialysis renal replacement therapy, can not completely eliminate toxins body disease urea, can not completely eliminate uremia caused by metabolic disorders, can not replace the endocrine function of the kidney. With prolonged dialysis, toxins accumulate, metabolic disorders and endocrine disorders caused by problems gradually worsened, can cause a number of complications, which seriously affects the quality of life and survival of patients.
1. Hypertension: Mainly due to sodium retention, increased activity of the renin-angiotensin system, increased excitability of the sympathetic nervous system and other causes.
First, the treatment should be limited intake of water and sodium, keep dry weight, 75% of patients can control blood pressure. Invalid can increase with antihypertensive drugs, the class of ACEIs channel blockers and calcium are first choice. 3% to 5% of patients are refractory hypertension, peritoneal dialysis or hemofiltration may be effective.
2. The left ventricular dysfunction: the etiology addition of hypertension, sodium retention, but also with anemia, acidosis, fistula, electrolyte imbalance, malnutrition etc. Dehydration adequate dialysis, keeping the dry weight is the main treatment, the other must correct the anemia, blood pressure control and nutritional therapy.
3. Coronary Artery Disease: More by the original based on ultrafiltration excessive causing coronary atherosclerosis coronary ischemia caused. Controlling high blood pressure, high cholesterol, correct anemia, weight maintenance among dialysis, prevent excessive dehydration etc., can effectively prevent its occurrence. The same treatment and patients not on dialysis. Angina occurred in dialysis treatment of kidney disease should slow blood flow ultrafiltration stop and breathe oxygen and sublingual nitroglycerin, you should be expanded low blood pressure. Patients ineffective treatment should cease hemodialysis treatment again. Done repeatedly can make peritoneal dialysis or hemofiltration.
4. Pericarditis: After two weeks start dialysis pericarditis occur, early pericarditis is called, after two weeks, late pericarditis is called, pathogenesis were unclear. Patients with early symptoms of pericarditis most have chest tightness, chest pain and pericardial rub, strengthens dialysis to treat effectively. Pericarditis most asymptomatic late, only in recurrent dialysis hypotension occur, in part to strengthen effective dialysis, peritoneal dialysis some needed.
5. Pulmonary edema: More due to overload caused by water, other causes of congestive heart failure, hypoalbuminemia and pulmonary capillary permeability etc. Adequate water ultrafiltration can rapidly improve symptoms. Restricted water intake, adequate dialysis and hypoproteinemia can be prevented effectively.
6. The pleural effusion: Exudative base. More in heart failure, sodium retention, renal syndrome, infection and other causes, in part explained uremic idiopathic pleural effusion. Treatment should be enhanced dialysis and ultrafiltration, hypoproteinemia, improve the general condition, if necessary, keep a breast pump fluid therapy.
7. Gastrointestinal diseases: including esophagitis, gastritis, ulcers, delayed gastric emptying and gastrointestinal bleeding. More urinary retention urinary toxins cause damage to the autonomic nervous disorders gastrointestinal motility, gastrin metabolic abnormalities lead to increased gastric acid secretion, anemia, malnutrition weaken mucosal protecting factors and other causes. Most effective treatment to strengthen dialysis, can also used drugs promote gastrointestinal motility, excluding protective agents gastrointestinal mucosa magnesium antacid agents. Gastrointestinal bleeding should pay attention to the choice of methods of anticoagulation.
8. The intestinal ischemia, intestinal infarction: High blood pressure, high cholesterol, heart failure, diabetes and other common diseases in hemodialysis patients and metoprolol, etc vasodilators, commonly used drugs may reduce the intestinal blood flow, once excessive ultrafiltration, and intestinal bowel can induce myocardial ischemia. It manifests as severe abdominal pain, nausea, vomiting, diarrhea, abdominal distension, shock. Early quick to add volume can relieve intestinal ischemia, such as intestinal infarction without suspicion effect, once the diagnosis to be treated surgically.
9. Liver disease: Since hemodialysis patients with renal anemia and repeated blood transfusions, increasing infection with hepatitis B and C, can cause deposition of iron in dirty, causing cirrhosis, silicone and silicone dialysis tube also can be deposited in cuasa liver damage. When Hemodialysis patients liver damage, rare jaundice, gastrointestinal symptoms were masked by uremia and early detection difficult. Treatment focuses on prevention, as the use of erythropoietin to reduce blood transfusions, avoid using aluminum agents etc.
10. Ascites dialysis-related: Most occurred in patients who had undergone dialysis, the reasons include sodium retention, peritoneal permeability increase, infection, hypoalbuminemia, heart failure, pericardial disease, cirrhosis etc. Should be excluded before treatment tuberculosis, liver cancer and ascites. Treatment includes limiting intake of sodium and water, adequate dialysis ultrafiltration, ascites reinfusion and download abdominal fluid, local glucocorticoid therapy department etc. Kidney transplantation is the fundamental solution of the method of refractory ascites.
11. Anemia: renal hormone erythropoietin (EPO) produces insufficient is the main reason. Other factors include: blood shortage of raw materials, the loss of blood dialysis, increased destruction of red blood cells, bone marrow fibrosis and aluminum intoxication. EPO is the primary means of dealing renal anemia, general subcutaneous 3000u of 2-3 times / week, HCT reach 30-33% of the dose can be reduced and maintained at this value HCT, other treatments, including strengthening dialysis, raw materials of supplemental blood dialysis reduce blood loss, severe anemia can be a small amount of blood transfusion.
12. The secondary hyperparathyroidism and renal osteodystrophy: Generally regarded hemodialysis patients as calcium and phosphorus metabolism, deficiency of active vitamin D3 and acidosis can cause secondary hyperparathyroidism (2-HPT), and 2-HPT is increased osteoclast , decreased synthesis of collagen fibers in bone, bone mineralization disorders etc, cause renal osteodystrophy. The clinical manifestations are bone pain, fractures, bone deformation, joint swelling and deformation, muscle strength, muscle tone decreases, metastatic calcification and tendon rupture etc. Further diagnosis based on clinical symptoms, serum calcium, phosphorus, I-PTH concentration and X ray bone etc. Bone biopsy is the gold standard for the diagnosis of renal osteodystrophy. The primary treatment is active vitamin D3 supplement, the other can also hemoperfusion and parathyroid surgery etc.
13. Urogenital: Urinary stones in hemodialysis patients, infections, cancer and impotence, loss of libido and other incidence rate was significantly higher. Kidney cysts also acquired common, which is caused by the same kidney disease has nothing to do with dialysis, can be complicated by bleeding, infection and malignancy. Treatment is symptomatic, severe nephrectomy.
14. Nervous System: Mainly aluminum intoxication, uremic toxins, retention of parathyroid hormone, vitamin, micronutrient deficiencies, water and electrolyte disturbance caused by other factors. Central lesions showed inattention, short films, paranoia, mental impairment, severe cases there is a language and movement disorders, and even seizures, dementia. Peripheral neuropathy showed the depth of feeling important obstacles small number of patients with dyskinesia advanced flaccid even paralysis. Autonomic neuropathy manifests as hypotension, sexual dysfunction, disorders of sweat secretion, gastrointestinal disorders. Treatment includes avoiding contact with the aluminum to improve dialysis, improve nutritional status, to correct anemia, hemofiltration or peritoneal dialysis diverted if necessary. Kidney transplantation is the most effective method.
15. Skin: Mainly for color changes of the skin, dryness, hair, nail changes itching and oral lesions. Some of strengthening effective dialysis, most only symptomatic treatment, no special treatment.
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