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In dialysis the patients’ blood will flow into dialyzer and water and metabolic wastes such as urea, creatinine, guanidines and other toxins will pass through the dialysis membrane and enter the dialyzate while blood cell, while cell and protein can not pass through so as to help clear the metabolic wastes out of the body.
We can see that dialysis has no direct effect on repairing kidney damages or improving kidney functions but only replacing the renal functions to discharge wastes and toxins, alleviate symptoms and extend life expectancy. Long term dialysis will cause patients become dependent on dialysis and the remaining renal intrinsic cells will gradually lose functions.
Therefore it is not advisable to start dialysis early,there are some indicators for starting dialysis in kidney failure.
Acute renal failure
1. Anuria or oliguria lasting for 48 hours with poisoning, congestive heart failure, pulmonary edema or brain edema;
2. BUN (blood urea nitrogen)≧80mg/dl or with daily rise of 16mg/dl;
3. Serum creatinine ≧6mg/dl;
4. Serum kalium≧6.5mmol/l;
5. Carbon dioxide binding force≦15mmol/l.
Chronic kidney failure
1. Endogenous creatinine clearance ≦10ml/min;
2. BUN (blood urea nitrogen)≧97.6mg/dl;
3. Serum creatinine≧10mg/dl;
In case of the following conditions, emergency dialysis is needed if medicines are not effective.
1. Serum kalium>6.5mmol/l;
2. Oliguria, anuria, serious edema with heart failure, pulmonary edema, cerebral edema;
3. Metabolic acidosis, PH <7.2
4. Pericarditis, alimentary tract hemorrhage, neurological and psychiatric symptoms.
In case of one of the following conditions, early dialysis should be considered.
1. Obvious deterioration of the systemic conditions and rapid progression of renal failure;
2. Severe anemia;
3. With the complications of diabetes, desmosis.
4. Children or elderly people.
The last but not the least is the patient’s illness and physical conditions. The above is just general indicators and they may not suitable for every renal failure patients.
