Primary prevention refers to screening or health education for people at high risk of causing kidney damage, or even the general population, for early detection of chronic kidney disease or prevention of CKD.
Increase the awareness rate of kidney disease
Since CKD starts insidiously, most kidney diseases have almost no symptoms in the early stage; even if there are symptoms, they may not be specific to kidney diseases, so they are easily ignored by patients and the time for treatment is missed.
According to a survey in Beijing, the awareness rate, early diagnosis rate and treatment rate of kidney disease are very low, for example, the awareness rate is only 8.7. CKD is characterized by high prevalence, huge medical costs, easy combination of cardiovascular diseases, high death rate and disability rate, and patients with end-stage renal disease need to undergo kidney dialysis, which will bring a heavy economic burden to families and society. Meng Lifeng, Department of Nephrology and Rheumatology, The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine
While the incidence of early CKD patients is 100 times higher than the incidence of renal failure, if early and effective intervention and treatment are carried out to control the risk factors, the progression of CKD can be delayed and even the incidence of renal failure can be reduced. Therefore, community doctors should effectively increase people’s awareness of CKD through various ways and means. At the same time, let patients understand that CKD is a lifelong disease and its treatment goal is not to cure but to keep patients living a normal life; treatment is not the core of CKD prevention and treatment, but patients’ lifestyle adjustment is the key.
Therefore, the role of medical and nursing staff is not only to prescribe medication to patients, but more importantly, to teach patients appropriate knowledge and some skills to change their lifestyles, so that patients can actively participate in the various decisions of treatment self-management.
Specific methods for early detection of kidney disease
1. Early screening of high-risk groups. High-risk groups include.
(1) the elderly.
(2) Patients with hypertension, diabetes mellitus, obesity or metabolic syndrome.
(3) Patients with repeated use of various drugs.
(4) Patients with CKD at home, etc.
2. Individuals should actively seek medical attention for the following symptoms.
(1) lack of energy.
(2) Sleep and disorders.
(3) Edema of the feet and ankles.
(4) Puffy eyelids (especially in the early morning).
(5) Increased frequency of urination (especially at night).
(6) Foam in the urine.
(7) Deepening of urine color (especially after a cold).
(8) High blood pressure.
3. Be highly alert to declining kidney function when the following symptoms occur.
(1) decreased appetite and nausea.
(2) Bad breath.
(3) pale face.
(4) dry, itchy skin.
(5) nocturnal cramps.
(6) Lack of energy.
(7) Poor concentration, headache, sleep disorder, etc.
People with the above manifestations should go to the hospital for routine urine and kidney function tests and, if necessary, kidney ultrasound. It is also beneficial to organize regular annual medical check-ups for employees in the unit for early detection of CKD, but after the check-ups, attention needs to be paid to timely re-examination according to the test results and doctor’s recommendations.
Secondary prevention: timely treatment
Secondary prevention means timely drug treatment for patients who have been clearly diagnosed with CKD to delay the deterioration of kidney function and prevent the occurrence of uremic syndrome.
The most commonly used drugs: immunosuppressants
Glucocorticoids (prednisone) and cytotoxic drugs (cyclophosphamide) are the most commonly used drugs to treat various primary or secondary glomerulonephritis. Glucocorticosteroids can play a role in eliminating urinary protein by suppressing immune and inflammatory responses through various pathways and by reducing the permeability of the glomerular basement membrane. The principles of treatment are to start with an adequate dose, reduce it slowly, and maintain it for a long time.
For patients who cannot use hormones or whose hormones and cytotoxic drugs are ineffective, other immunosuppressive drugs can be used instead, such as cyclomycin, primaquine, leflunomide, and Chinese herbal medicine rehmannia multi-glucoside. Since immunosuppressants usually have more side effects, they need to be used under the guidance and close monitoring of a specialist.
Antihypertensive drugs: need to be used consistently
Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor antagonists (ARB), two types of drugs that block the renin-angiotensin-aldosterone system, can not only lower blood pressure, but also have a unique renoprotective effect, reducing urinary protein in patients with normal or abnormal blood pressure and delaying the progression of renal damage. However, these two classes of drugs are contraindicated in the presence of dehydration or moderate or severe renal insufficiency, as well as in patients with bilateral renal artery stenosis. Other antihypertensive drugs, such as calcium channel blockers and diuretics, are also widely used in chronic kidney disease.
Nutritional agents: inhibit urea production
Such as Kai Tong, which contains 4 types of calcium ketoamino acids, 1 type of calcium hydroxyamino acids and 5 types of essential amino acids. The administration of this nutritional preparation allows the body to reuse nitrogen, thus inhibiting urea production and improving protein metabolism. Erythropoietin and iron can also be used to correct anemia.
Phosphorus binding agents: improving calcium and phosphorus metabolism
Calcium carbonate can be used in patients with chronic renal insufficiency who have disorders of calcium and phosphorus metabolism to correct hypocalcemia and hyperphosphatemia. Other phosphorus-binding agents include calcium acetate, aluminum hydroxide gel, and lanthanum carbonate.
The active vitamin osteotriol, the main active component of vitamin D, promotes calcium absorption by the renal tubules in the small intestine, thereby correcting hypocalcemia, and inhibits hyperthyroidism due to chronic renal insufficiency.
Sodium bicarbonate: Adjusts acid-base balance. It is mainly used to correct metabolic acidosis in patients with chronic renal insufficiency.
Diuretics: Decrease swelling and lower blood pressure. Mainly used for diuretic swelling and hypertension and treatment.
Detoxification drugs: promote toxin excretion. Including medicinal activated charcoal and some drugs that promote stool excretion.
Tertiary prevention: prevent complications
Tertiary prevention refers to treatment measures for patients with declining renal function to prevent certain serious complications (such as acute left heart failure, hyperkalemia, uremic encephalopathy, serious infections, bleeding, etc.). And these complications can directly threaten patients’ lives.
Find and get rid of the cause of the disease
Many patients are very nervous after their kidney function does decline, but at this time, it is important to remember to seek medical help when there is a disease. We found that most of the patients can find the causes of kidney function decline, and often can effectively protect kidney function after eliminating these causes.
Common causes of declining kidney function are.
1, dehydration.
2.Low blood pressure.
3, use of nephrotoxic drugs.
4, urinary tract obstruction.
5, infection.
6, severe hypertension.
7, water-electrolyte disturbances.
8, high protein diet.
9, severe hyperparathyroidism.
10, high catabolic state in the body.
11.Heart failure.
Guide the patient to choose the dialysis method reasonably
First, help the patient to clarify that the goal of dialysis is to let the patient live longer and live with quality. Second, help patients understand that each dialysis modality has its own advantages and disadvantages, that dialysis modalities can be changed if needed, and that dialysis treatment is constantly advancing.
Patients should be helped to understand the process of dialysis.
Hemodialysis is the process of introducing the patient’s blood into the hemodialysis equipment through a vascular fistula and exchanging the toxins in the patient’s blood into the dialysis solution through ultrafiltration and osmosis. After some “cleaning”, the clean blood is then returned to the patient’s body. Usually, hemodialysis is performed about three times a week.
2. Peritoneal dialysis uses the filtration function of the human peritoneum to replace the role of a hemodialysis machine, without introducing blood into the body. The most common form of peritoneal dialysis used today, continuous ambulatory peritoneal dialysis, for example, uses gravity to deliver dialysis fluid into the peritoneal cavity, like an infusion, after a dialysis tube is placed into the patient’s abdomen through minor surgery, and the fluid is changed at regular intervals for the purpose of continuous dialysis. A large body of evidence shows that there is no significant difference in the prognosis and quality of life between abdominal dialysis and hemodialysis treatment based on the existing treatment protocols.