What conditions are indicated for hemodialysis?

Indications for hemodialysis:

1. Acute kidney injury: Those with acute kidney injury and hypercatabolism (daily blood urea nitrogen bun rise, serum creatinine SCR rise, serum potassium rise 1-2mmol L, HCO3- decrease 2mmol L) can be dialyzed**. Dialysis can be performed if the person who is not highly catabolic but meets the first of the following and has any other item:

No urine for more than 48 hours; bun≥；scr≥442umol/l；Serum potassium ; HCO3-<15 mMOL L, CO2 binding capacity < 13 mMOL L; There is significant edema, pulmonary edema, nausea, vomiting, drowsiness, agitation, or impaired consciousness; Hemolysis and free hemoglobin caused by accidental transfusion of abnormal blood or other causes. The decision to start renal replacement immediately** and which modality to choose should not be based on a single indicator, but should be considered as a whole.

2. Chronic renal failure: There is no unified standard for the timing of hemodialysis for chronic renal failure, and due to medical and economic constraints, hemodialysis for most patients in China starts late. Indications for dialysis:

Endogenous creatinine clearance < 10ml min; bun>, or scr>; hyperkalemia; metabolic acidosis; uremia odor in the mouth accompanied by loss of appetite and nausea, vomiting, etc.; Patients with chronic congestive heart failure, renal hypertension or uremic pericarditis generally ineffective; Neurological symptoms of uremia, such as personality changes, restless legs syndrome, etc., are present. The timing of starting dialysis should also be determined based on a combination of abnormal indicators and clinical symptoms.

3. Acute drug or poison poisoning: Dialysis can be used for drugs and poisons that can be removed through the dialysis membrane, that is, the molecular weight is small, does not bind to tissue proteins, and is evenly distributed in the body**. It should be done within 8 to 12 hours of ingestion, and critically ill patients can start dialysis without waiting for test results**.

4. Other diseases: severe water, electrolyte and acidolytic balance disorders, which are generally difficult to work and hemodialysis may be effective.

Hemodialysis is one of the ways to replace the kidney in patients with acute and chronic renal failure. It drains blood from the body to the outside of the body, through a dialyzer composed of countless hollow fibers, the blood and the electrolyte solution containing similar concentrations of the body (dialysate) inside and outside the hollow fibers, through diffusion convection for material exchange, remove metabolic wastes in the body, maintain electrolytes and acid-base balance; At the same time, the entire process of removing excess water from the body and returning the purified blood is called hemodialysis. Acute kidney injury is a group of clinical syndromes that refers to a sudden (within 1-7 days) and persistent (> 24 hours) sudden decline in renal function, defined as an increase in serum creatinine (SCR) of at least 1, manifested by azotemia, water-electrolyte and acid-base balance, and systemic symptoms, which may be accompanied by oliguria (< 400 ml for 24 hours or 17 ml for 24 hours) or anuria (< 100 ml for 24 hours).

Pathological state of partial or total loss of renal function. According to the severity of its onset, it is divided into acute and chronic. Acute renal failure is the loss of excretory function of the two kidneys in a short period of time due to a variety of diseases, referred to as acute renal failure.

Chronic renal failure is a complex of clinical symptoms that occur when chronic kidney disease progresses to an advanced stage due to various **. Dialysis** needs to be started as soon as possible, which has the functions of dehydration, toxin removal, correction of electrolyte imbalance and acid-base imbalance, so that patients can get through the difficulties of oliguria. During the polyuria phase, water and electrolyte balance are strictly monitored to prevent death from dehydration and electrolyte imbalances.

During the recovery period, it is important to pay attention to nutrition, rest and avoid nephrotoxic drugs.

Indications for hemodialysis for chronic renal failure.

Serum urea. Serum creatinine.

Endogenous creatinine clearance 10 ml min.

There are obvious uremia symptoms such as anorexia, nausea, and vomiting.

Indications for emergency dialysis:

Uncontrolled hyperkalemia.

Metabolic acidosis, pH <

There are significant signs of water retention, such as severe edema with heart failure, pulmonary edema, and hypertension.

Complications include uremic pericarditis, gastrointestinal bleeding, central nervous system symptoms such as trance, drowsiness, coma, convulsions, psychiatric symptoms, etc. Blindness.

Indications for hemodialysis for acute renal failure.

1.Confirm the diagnosis.

2. Oliguria or anuria for more than two days.

3.Blood urea nitrogen.

4.Serum myachai empty anhydride 442mol l (5mg dl)5, serum potassium or electrocardiogram with hyperkalemia.

6.Hypercatabolism (daily increase in blood urea nitrogen by more than 10 mol L, serum creatinine increase by 177 mol L or serum potassium increase by 1-2 mmol L or more).

Emergency dialysis should be performed in the following cases:

1.Serum potassium 7 mmol l

2.Carbon dioxide binding force 15mmol l

3. pH value <.

4.Urea nitrogen 54 mmol l

5.Serum creatinine 884umol l

6.Acute pulmonary edema.

Acute Chinese Medicine. Drugs or poisons that do not bind to proteins, are evenly distributed in the body, and have a small molecular weight can pass dialysis**.

Relative contraindications to hemodialysis.

or shock systolic blood pressure is lower.

People with severe bleeding or bleeding tendency.

Severe cardiopulmonary insufficiency includes arrhythmias, myocardial insufficiency, or severe coronary heart disease.

People with severe infections such as sepsis or bloodborne infectious diseases.

Uncooperative patients.

1 In principle, hemodialysis has only relative contraindications, and there are no absolute contraindications. It is not only suitable for acute and chronic renal failure, but also for some internal diseases and some drug poisoning, please do it under the guidance of a doctor.

2. Patients with acute renal failure who have any of the following are indications for hemodialysis:

1.Oliguria for more than 3 days (less than 400 ml d) or no urine for two days (less than 100 ml d).

2.water retention, pulmonary edema, pleural effusion, etc.; bleeding tendencies (e.g., gastrointestinal bleeding); Psychiatric neurological symptoms.

3.Serum creatinine is greater than, blood urea nitrogen is greater than.

4.Serum potassium greater than.

5.Blood HCO3 - less than 15 mmoll L

6.Hypermetabolic status, with a daily increase in serum creatinine and/or a daily increase in blood urea nitrogen, a daily increase in serum potassium greater than 1 mmol, or a decrease in carbon dioxide binding capacity of less than 2 lmmol per day.

31.Clinical symptoms.

Oliguria, increased nocturia.

Renal anemia Severe hypertension.

Insomnia, headaches.

Vice, vomiting.

Body fluid retention Those who have more than three of the above six items.

2.Renal function test: serum creatinine greater than 8mg dl, creatinine clearance less than 10mi min

3.Mild difficulty in moving: patients with mild difficulty in moving due to chronic renal failure.

41.Hyperkalemic blood signs, which cannot be corrected by internal medicine routines**.

2.Severe metabolic acidosis, which cannot be corrected by drugs.

3.Water retention, high edema (generalized edema, pleural effusion, ascites, etc.).

4.Hypercalcemia.

5.Hyperuricemia.

6.Certain drugs are poisoned (suitable for drugs with small molecular weight, low water-soluble binding to plasma proteins).