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If you already have an artificial kidney, don't you need dialysis?

In the face of various treatments and drugs, our patients with nephropathy are most afraid of "dependence": they are afraid of hormone dependence and are unwilling to use hormones, afraid of antihypertensive drug dependence and dare not take antihypertensive drugs, afraid of dialysis dependence and refuse dialysis. In the doctor's opinion, there is no so-called "dependence", but only the "need" of the disease. Whether it is hormones, antihypertensive drugs or hemodialysis, they are all a kind of drugs or a means for nephrologists to treat kidney diseases. Even if you understand it as "dependence", it is because of the lack of certain functions of the human body.

Today, I mainly talk about dialysis. Originally, about 2 million nephrons were responsible for purifying our blood. However, due to the severe damage of kidneys of patients with renal failure, the renal function has been seriously reduced, and the work of purifying blood can only be done by machines (artificial kidneys), so the so-called dialysis dependence appears. In fact, patients need hemodialysis as a treatment.

for patients with chronic kidney disease (CKD), whether dialysis dependence exists depends on the timing of treatment in CKD 1-5, such as uremia (mainly seen in those patients with slow development and obvious atrophy of both kidneys, and there is no irreversible factor at all), and of course long-term dialysis is needed.

However, for those patients whose serum creatinine rises rapidly due to "slow+acute" (chronic kidney disease complicated with acute kidney injury), under the premise of using drugs to correct the inducement causing the rapid rise of serum creatinine, it may be necessary to combine hemodialysis treatment, and it takes several times (rarely more than a dozen times) to get through the critical period, which is called "temporary dialysis", and generally long-term dialysis is not necessary.

There is another type of renal failure patients who need dialysis, namely "acute", that is, acute renal failure. We say that renal failure patients who need temporary dialysis are far more than the above, and others include acute tubular necrosis, severe acute allergic interstitial nephritis, lupus nephritis complicated with acute renal failure and acute progressive nephritis, etc. According to the needs of the disease, some may need dialysis several times, and some may need dialysis more than ten times or more. Once the critical period is over, the "inflammation" has improved, the agitation period has been controlled, and the urine volume has gradually increased, patients can completely leave dialysis and switch to drugs and other treatments (that is, non-dialysis treatment).

To sum up, as a treatment, hemodialysis can be used for temporary dialysis or long-term dialysis of patients with renal failure. Don't equate "needing dialysis" with "permanent dialysis" (that is, "needing dialysis ≠ permanent dialysis"), and don't always want to get rid of dialysis for kidney patients who need long-term dialysis. Nor can we think that some patients with kidney disease can get rid of dialysis and go to hospital everywhere, thus giving cheaters' hospitals (some private hospitals) an opportunity.

Let's talk about glucocorticoid first: each of us will produce it, which is mainly secreted by adrenal gland (not the kidney, but the gland above the kidney), which is mainly used to inhibit inflammatory reaction, protect kidney cells from damage and so on. There are two reasons for glucocorticoid dependence: one is due to insufficient adrenal secretion, and the other is due to persistent inflammatory reaction. It sounds like dependence, but it is actually a need.

Let's talk about antihypertensive drugs again. Repeated blood pressure measurements have definitely diagnosed nephropathy complicated with hypertension. If we don't take antihypertensive drugs, it will definitely cause damage to the heart, brain, kidney and other important organs of this nephropathy patient. Most of this damage occurs unconsciously (in severe cases, there are sudden changes in the condition, such as stroke, heart failure and acute renal failure). For such patients, antihypertensive drugs are most needed.