Hyun Eun-kyung, 50, a nurse who died while rescuing patients at a kidney dialysis hospital in Icheon-si, Gyeonggi-do, was unable to evacuate because she had to remove the dialysis machine from the patients despite the toxic gas from the fire. Although she had enough time to escape, she stayed until the end to help the patients evacuate. There are growing calls for her to designate the deceased as a doctor. With this incident as an opportunity, interest in dialysis is high. Learn about kidney health and dialysis.
◆ Dialysis, why is it necessary… 3 times a week, 4-5 hours each time required
The kidneys play a very important role, such as removing waste products from the body and balancing water. However, even when the disease occurs, there are often no symptoms, so it is detected late and the treatment time is missed. According to the Korea Centers for Disease Control and Prevention, when chronic kidney disease progresses and the kidney function is lowered to less than 15% of normal for more than 3 months, it is diagnosed as ‘end-stage renal failure’. Dialysis and kidney transplantation may be necessary if kidney function declines, waste products accumulate in the blood, and edema develops. ‘Dialysis’ is a method of removing excess waste and water from the blood, and there are ‘hemodialysis’ and ‘peritoneal dialysis’.
Hemodialysis requires the creation of an arteriovenous fistula, a vascular device, in the arm before starting dialysis. Dialysis should be performed at a nearby hemodialysis room (hospital, clinic), usually 3 times a week, for 4 to 5 hours each time. It interferes with daily life because you have to come to the dialysis room at the hospital-clinic. Be careful with food and water consumption. Unlike hemodialysis, peritoneal dialysis does not require needle puncture. If you have a dialysis space, you can perform self-dialysis on your own. However, you need to learn how to treat it and manage it well. It is cumbersome to change the dialysate in a clean environment 2 to 4 times a day.
◆ The cause of kidney disease… diabetes, high blood pressure, etc.
Chronic kidney disease can usually be detected with a urine test. Causes are 1) diabetes 2) high blood pressure 3) glomerular disease 4) polycystic kidney disease 5) urinary tract obstruction (kidney and urolithiasis, enlarged prostate, etc.) 6) infection (recurrent pyelonephritis, renal tuberculosis, etc.) 7) nephrotoxic drug Use (anti-inflammatory analgesics, extracts, nephrotoxic antibiotics, etc.), etc. As chronic kidney disease progresses to end-stage renal failure, the severity increases. The 5-year survival rate of dialysis patients in Korea is about 60%, which is lower than that of cancer patients. In particular, in patients with end-stage renal failure due to diabetes, the 5-year survival rate is very low, about 54%.
◆ Kidney is bad… What are the main symptoms?
1) Edema and high blood pressure = Salt from the body must be properly discharged through the kidneys, but if this function is reduced, salt and water accumulate, causing swelling of the body and high blood pressure. Usually, when you wake up from sleep, your face or hands and feet are swollen, and in the afternoon, the body fluids are pushed down the body under the influence of gravity and your legs are swollen. A typical symptom is that shoes that fit well in the morning become tight in the afternoon.
2) Heart failure, heart failure = When water accumulates in the body and edema worsens, the burden on the heart increases and heart failure may occur. Heart failure is a condition in which blood does not circulate properly and stagnates in the heart and lungs, causing the heart to enlarge and water to fill the lungs, causing shortness of breath. If edema worsens, high blood pressure that cannot be controlled with existing blood pressure medications may occur.
3) A sense of helplessness, uremia = If the kidney function is not properly excreted, uremia may occur. In particular, protein is a compound containing nitrogen and sulfur, so it must be excreted through the kidneys. When kidney function decreases, nitrogen, phosphorus, and sulfur compounds, which are metabolites of proteins, cannot be removed and remain in the body to become toxic substances. This toxic reaction is called uremia. The main symptoms are weakness, weakness, nausea, vomiting, itching, tingling, convulsions, and changes in consciousness.
4) Weakness, anemia = If the electrolyte balance in the body is disrupted due to kidney failure, weakness, myasthenia gravis, tingling symptoms, and cardiac arrhythmias may occur. In addition, if the acid to be excreted by the kidneys is not properly excreted, metabolic acidosis in which the function of the central nervous system is lowered may occur. Anemia may also occur.
◆ Kidney disease prevention and lifestyle for management?
1) In order to prevent kidney disease, it is necessary to first prevent diabetes and high blood pressure. If you already have it, you need a low-sodium diet to slow the deterioration of your kidney function. It is recommended to limit salt intake to less than 5 g per day. It is also effective in preventing and controlling high blood pressure.
2) Smoking promotes the development and exacerbation of chronic kidney disease. If you experience kidney problems, you should immediately stop smoking. Weight management is also important. Obesity puts a strain on the kidneys, which can lead to or worsen chronic kidney disease.
3) If you already have kidney disease, you should reduce your protein intake. Because protein metabolites are only eliminated by the kidneys, eating less protein can reduce the build-up of uremic substances and slow the deterioration of kidney function. However, this leads to a decrease in muscle mass and nutritional deficiencies, which can lead to various complications in chronic kidney disease patients. Therefore, sufficient calorie intake of 35-50 kcal/kg per day is required.
4) It is important to check if there is microproteinuria or hematuria through a urine test every year. Check the health of the glomerulus of the kidneys and drink water frequently to avoid kidney-urolithiasis.
Reporter Kim Yong-eok [email protected]
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