Chronic renal failure anemia treatment

Written by Zhang Hui
Nephrology
Updated on September 10, 2024
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Patients with chronic renal failure generally have anemia combined with stage three or above of chronic kidney disease (CKD). When the hemoglobin falls below 100 grams per liter, it is necessary to start treatment to correct anemia. At this point, relevant lab tests should be conducted to check for abnormalities in folate, vitamin B12, ferritin, and serum iron levels, and specific treatments should be administered accordingly. Treatments generally include iron supplements, erythropoiesis-stimulating agents, folate, and vitamin B12 to help correct anemia.

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Principles of Treatment for Chronic Renal Failure

The principles of treatment for chronic renal failure include early-stage non-dialysis conservative treatment as well as end-stage renal replacement therapy. Non-dialysis conservative treatment includes delaying the progression of kidney damage, which requires treating the primary disease, implementing nutritional support, and controlling factors that accelerate kidney disease progression, such as controlling high blood pressure, proteinuria, and hyperlipidemia. Additionally, it is necessary to eliminate metabolic waste from the body, and maintain the body's water, electrolyte, and acid-base balance. Renal replacement therapy includes hemodialysis, peritoneal dialysis, and kidney transplant therapy.

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Chronic Renal Failure Replacement Therapy

Chronic kidney failure is the irreversible loss of nephron units and kidney function caused by the progressive progression of chronic kidney disease, leading to a clinical syndrome characterized by the retention of metabolic products and toxins, disturbances in electrolyte and acid-base balance, and endocrine disorders. Chronic kidney failure often progresses to end-stage kidney disease, and the late stage of chronic kidney failure is called the uremic stage. After entering the uremic stage, renal replacement therapy is often required, with the main methods being hemodialysis, peritoneal dialysis, and kidney transplantation.

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What is the blood pressure in chronic renal failure?

High blood pressure is a common complication of chronic renal failure, with about 70 to 80 percent of patients experiencing elevated blood pressure. Controlling blood pressure is also an important aspect of the treatment of chronic renal failure. Generally, it is best for such patients to keep their blood pressure below 130/80 mmHg, with systolic pressure below 130 mmHg and diastolic pressure below 80 mmHg. If a patient’s 24-hour urinary protein quantification exceeds 1 gram, the blood pressure control requirements are even more stringent, ideally below 125/75 mmHg. Adequately controlling blood pressure also helps to slow the progression of chronic renal failure.

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Diet for Patients with Chronic Renal Failure

Patients with chronic kidney failure should first pay attention to a low-salt and low-fat diet, with daily salt intake less than six grams, and try to eat less salty food such as pickled vegetables and preserved products. Additionally, due to the impaired excretion of potassium and phosphorus in patients with chronic kidney failure, it is necessary to eat less high-phosphorus and high-potassium foods. Common high-phosphorus foods include various marinated meats and other processed foods, and common high-potassium foods include fruits such as bananas, peaches, mangoes, and vegetables like green vegetables and potatoes. At the same time, it is important to maintain a high-quality, low-protein diet. If dialysis treatment has not yet been started, protein intake should be controlled at 0.6 grams per kilogram of body weight per day. If dialysis treatment has already begun, the standards can be appropriately relaxed.

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Symptoms of chronic renal failure

The clinical symptoms of chronic renal failure vary at different stages. In the compensatory and early decompensatory stages of chronic renal failure, patients may experience no symptoms or only mild discomforts such as fatigue, back pain, and increased nocturia, while a few may suffer from reduced appetite, metabolic acidosis, and mild anemia. The main clinical symptoms include disorders of water, electrolyte, and acid-base balance, presenting metabolic acidosis, sodium retention or hypovolemia, or hyponatremia, along with hyperkalemia. Moreover, there are significant manifestations of excess phosphorus and calcium deficiency. Patients may also experience disruptions in the metabolism of proteins, carbohydrates, fats, and vitamins. Cardiovascular symptoms mainly include hypertension, left ventricular hypertrophy, heart failure, and uremic cardiomyopathy. Gastrointestinal symptoms can manifest as loss of appetite, nausea, and vomiting. Hematological manifestations may include renal anemia and a tendency to bleed.