What You Need To Know about Hemodialysis？

What is hemodialysis?

The blood is drawn out of the body and passes through a dialyzer made of the principle of "semi-permeable membrane" to remove excess water and metabolic waste from the body, adjust acid-base and electrolyte balance, and then return the purified blood to the body to replace the diseased kidneys The removal of water and solutes that cannot be completed to achieve the purpose of treatment is called hemodialysis.

Indications

(1) Uremic syndrome.

(2) Cerebral edema, pulmonary edema and hypertension caused by volume overload.

(3) Uremia combined with neurological and psychiatric symptoms.

(4) Uremic pericarditis.

(5) Blood urea nitrogen ≥28mmo1/L, blood creatinine ≥530~840μmo1/L.

(6)Ccr<10ml/min.

(7) Serum potassium ≥6.5mmol/L.

(8) Uremic anemia, Hb<60g/LHCT<15%.

(9) Reversible chronic renal failure, preparation before kidney transplantation, acute renal failure caused by acute rejection after kidney transplantation, or chronic rejection when the transplanted kidney loses function.

(10) Others: such as some drug poisoning, hypercalcemia, metabolic alkalosis, free hemoglobin >80mg/L during hemolysis.

Small details for patients

1.Hemodialysis mainly involves extracorporeal circulation of human blood. Therefore, in order to maintain the environmental hygiene of the dialysis room and prevent infection, patients must change into special slippers for the dialysis room when entering the dialysis room. After changing, you can measure your blood pressure and weight by yourself. If you add or remove clothes or use a wheelchair, you must accurately weigh the weight of the added or removed clothes or wheelchair so that the doctor can accurately set the amount of dehydration for you.

2.Dialysis patients must bring tourniquets according to their needs. Patients prone to hypoglycemia should bring candies, biscuits and other foods. If you have bleeding or potential bleeding, black stool, dark brown vomitus, recent surgical arrangements or trauma, etc., you should inform them in advance or call the doctor or nurse to arrange treatment in advance.

3.During dialysis: Patients should try not to drink or eat during dialysis to avoid choking and suffocation. The most important thing is that when eating, the blood in the circulatory system will be concentrated in the digestive system, resulting in insufficient blood perfusion in important organs such as the brain, which will cause dizziness, palpitation, and symptoms of hypotension. Therefore, it is best to drink water before or after dialysis.

4.At the end of dialysis: measure blood pressure and weigh (wear the same clothes as before dialysis). Observe the blood leakage at the puncture point frequently, and remember the time to loosen the bandage for arteriovenous fistula dialysis patients. You should bring your own weight scale at home to keep track of changes in your weight at any time.

Precautions for new patients before and after dialysis

At the beginning of dialysis, multiple short-term dialysis is used. The first time does not exceed 2 hours, and then gradually increases to 4 hours. After 1 to 2 weeks of induction, regular dialysis can be entered (3 times a week is appropriate).

For patients undergoing dialysis for the first time, blood flow should be increased slowly. Factors that affect blood flow include mental factors, vasospasm caused by excessive stress, and vascular conditions, and the patient should gradually adapt. Reduce integrative reactions.

Measure blood pressure every 30-60 minutes to closely observe changes in the condition, such as nausea, vomiting, dizziness or headache, cramps, chest tightness, chest pain, cold sweat, itchy skin, abdominal pain, and back pain. Tell medical staff promptly so they can be treated as soon as possible.

After dialysis: Master the time to loosen the bandage. If there is bleeding during the journey, press the puncture point immediately. It is better to ensure that there is no bleeding and the blood vessel tremors can be felt. You cannot take a shower on the day after dialysis. The band-aid can be removed after 24 hours. You can also apply some medicine around the internal fistula to soften blood vessels and scars.

Common complications of hemodialysis

1.Muscle spasm: local muscle tonic contraction (cramp) occurs during dialysis or within a few hours after dialysis, and the pain is severe. It usually occurs in the lower limbs, but can also occur in the abdomen and chest. In patients undergoing routine dialysis, muscle rigidity often occurs in the second half of dialysis, and may be accompanied by a drop in blood pressure at the same time or subsequently. The main reason is that too fast or too much dehydration reduces the amount of circulating blood in blood vessels, leading to intramuscular dehydration.

2.Hypotension: The main reason is the decrease in blood volume caused by excessive dehydration or excessive speed. Some patients also have poor vascular compliance. After the occurrence of hypotension, the blood supply to the heart, brain and other important organs is seriously insufficient, which should be avoided as much as possible and corrected quickly after the occurrence. For prevention, you can choose hemofiltration that has less impact on plasma osmotic pressure; hemodiafiltration is more suitable.

3.Hypertension: It often occurs in the middle and late stages of dialysis. The exact cause is not completely clear. It is generally believed to be related to factors such as the increase in blood renin activity caused by dialysis and the imbalance syndrome caused by the clearance of small molecule uremic substances. Severe cases may have headaches, nausea and vomiting, etc., which generally cannot be relieved on their own and have poor response to drug treatment. Most of them can be relieved after dialysis. When blood pressure is difficult to control and symptoms are severe, intravenous sodium nitroprusside can be used. Dialysis should be stopped when treatment is ineffective.

4.Imbalance syndrome: Mainly because small molecular substances such as urea nitrogen in the blood are quickly cleared, and the osmotic pressure in the plasma is reduced. At this time, the urea nitrogen in extravascular tissues and cells has not yet been cleared, and the osmotic pressure is higher than that of the plasma. , caused by the transfer of water from plasma to tissues and cells. In the central nervous system, it can cause cerebral edema, increase in intracranial pressure, cause headache, nausea and vomiting, increase in blood pressure, disturbance of consciousness, spasm, etc. Changes in osmotic pressure can increase intraocular pressure in some patients, manifesting as eyeball swelling and pain, orbital and forehead headaches.

5.Pericarditis and pericardial effusion: When pericarditis and pericardial effusion occur during dialysis, the patient will experience chest tightness, suffocation, and inability to lie down. He or she will cough and wheeze with the slightest movement, unable to move, unable to eat, sleepless at night, and even The vomiting will not stop.

6.Anemia: Long-term hemodialysis patients are almost always accompanied by varying degrees of anemia, which gradually worsens. The clinical manifestations include palpitations, shortness of breath, difficulty breathing, body aches, difficulty walking, gloomy complexion, and pale lips.

7.Malnutrition: (1) The patient is malnourished; (2) Dialysis is insufficient (3) Nutrition is lost during dialysis. Hemodialysis loses 10 to 30 grams of amino acids and peptides each time, along with the loss of various water-soluble vitamins and trace elements; (4) Adverse reactions cause nausea, vomiting, and loss of appetite in patients.

Dietary principles for hemodialysis patients

Eat more high-quality protein, pay attention to vitamin supplements to meet the body's repair needs, and limit the intake of sodium, potassium and phosphorus. During long-term maintenance hemodialysis, many nutrients can be lost, especially the loss of protein, accompanied by the loss of inorganic salts and trace elements, which can easily cause electrolyte disorders; in addition, long-term loss of appetite and nausea can be caused by toxins in the body. Many factors such as vomiting and insufficient nutritional intake can easily lead to malnutrition. Therefore, it is necessary to supplement nutrition in time and eat a diet rich in high-quality protein, vitamins, calcium and sufficient calories.

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