1.At what level should blood pressure be controlled in chronic renal failure?
Most patients with chronic renal failure have hypertension, which is the main factor leading to progressive deterioration of renal function in chronic kidney disease, therefore, timely and reasonable control of blood pressure and strengthening follow-up are the two main factors to slow down the progression of chronic renal failure. 24-hour continuous and effective control of hypertension plays an important role in protecting target organs, and blood pressure in patients with chronic renal failure should be controlled at around 120/85mmHg.
2.What should I pay attention to in order to control blood pressure diet?
Hypertensive patients should have a low-salt diet, and the limitation of sodium should be based on the presence or absence of edema and the degree of hypertension and 24-hour urine output. Those who have edema, relatively high blood pressure and high urine volume, generally consume 2-3g/d of refined salt, while for sodium loss nephropathy can be increased to 3-4g/d.
3.What are the antihypertensive drugs available for our patients with chronic renal failure?
There are six major categories of antihypertensive drugs: diuretics (hydrochlorothiazide, furosemide, spironolactone, etc.), beta-blockers (betalactam, Conotoxin, etc.), calcium antagonists (bethanechol, lorazepam, etc.), angiotensin-converting enzyme inhibitors (ACEI) (captopril, perindopril, etc.), angiotensin II receptor I antagonists (ARB) (valsartan, irbesartan, etc.), alpha receptor antagonists (terazosin hydrochloride, etc.). terazosin hydrochloride, etc.). Chronic renal failure due to reduced renal function is somewhat restricted, safer and beneficial antihypertensive drugs are calcium antagonists, angiotensin-converting enzyme inhibitors (ACEI), angiotensin II receptor I antagonists (ARB), alpha-blockers.
4.Why do doctors recommend calcium antagonists to control blood pressure in patients with chronic renal failure?
Calcium antagonists have the effect of inhibiting calcium inward flow, which can directly relax vascular smooth muscle, dilate small peripheral arteries, reduce peripheral vascular resistance, and achieve the purpose of lowering blood pressure. It has been reported that although calcium channel blockers do not affect glomerular intracapillary pressure and glomerular filtration rate, they also have the effect of preventing glomerulosclerosis, and are therefore the more desirable drugs for the treatment of hypertension in chronic renal failure.
5, angiotensin converting enzyme inhibitor (ACEI) is all chronic renal failure hypertension can be used?
In addition to lowering blood pressure, ACEI also has its unique effect of reducing hyperfiltration, mainly through the expansion of small arteries to achieve; and has the effect of reducing proteinuria, may also have antioxidant, reduce glomerular basement membrane damage and other effects, so it is often used as the ideal drug for chronic renal failure hypertension, especially with proteinuria is preferred. However, not all patients can be used, with hyperkalemia, bilateral renal artery stenosis, renal function is significantly impaired, such as blood creatinine > 265, 2μmol/L (3mg/dL) is prohibited.
6.What are the angiotensin converting enzyme inhibitors (ACEI)?
ACEI can be divided into three categories according to their chemical structure: a. Mercaptans: Captopril is the main one, which has a short duration of action and needs to be taken 2 to 3 times a day to ensure that blood pressure is fully controlled. b. Carboxylates: Enalapril, Benazepril, Ramipril, etc. are commonly used, which have a long duration of action. ), etc., the effect is long, generally 1 dose can be maintained for 24h. c. Phosphonates: Fosinopril is the representative.
7, angiotensin II receptor I antagonists (ARB) are what drugs?
ARBs can also be divided into three major categories.
(1) Biphenyltetrazole class: Losartan and Irbesartan are the main ones.
(2) Non-biphenyltetrazole: SKF108566, R117289 are the main ones.
(3) Non-phenylcycles: Valsartan (Valsartan), CQP45933 are mainly used. At present, clinically commonly used are cloxacin and valsartan.
8.What should I pay attention to when using ACEI and ARB?
Some patients may experience elevated blood potassium during the application of ACEI and ARB, generally with an average increase of 0,4 mmol/L. It is rare for blood potassium to rise above 6-8 mmol/L. However, attention should still be paid to elevated blood potassium during the use of ACEI, and should be avoided when the blood potassium level is 5 mmol/L. Regarding the side effects such as cough during ACEI, it is mainly related to the increase of some kinins and P substances caused by these drugs, which can be replaced with ARB when necessary.
9.Why should not use thiazide diuretics and beta blockers?
Thiazide diuretics used to treat hypertension can lead to lipid disorders, especially elevated TG and LDL-cholesterol. beta-blockers can further aggravate hypertriglyceridemia. Because these drugs reduce lipolytic activity, thus slowing down the metabolism of triacylglycerol-rich substances. Therefore, they should not be used.
10.What is hyperkalemia?
Potassium ion is the most important cation in the body and 90% of potassium is excreted through the kidneys. For patients with renal insufficiency, especially those on hemodialysis, potassium intake cannot be excreted sufficiently and hyperkalemia is likely to occur.
11.What are the symptoms of hyperkalemia?
The early symptoms are numbness of the skin around the mouth and limbs, weakness, muscle pain, and then a slowed heart rate, most dangerous to cardiac arrest leading to death.
12.How to treat hyperkalemia?
(1) Stop using foods and drugs that contain high potassium.
(2) Take calcium supplements. Calcium ions can antagonize the toxic effect of potassium ions on the heart muscle.
(3) Input glucose plus insulin, sodium bicarbonate and other fluids to temporarily transfer potassium ions into the cells, but large amounts of fluids need to be input.
(4) Oral administration of potassium-lowering resin drugs.
(5) Hemodialysis is the most rapid and effective treatment for lowering blood potassium.
13.How to prevent hyperkalemia?
(1)Reduce the intake of foods containing high potassium, such as: mushrooms, beans, nuts, fruits, dark vegetables, salted vegetables, etc. Hint: vegetable soup and juice contain high potassium, please avoid them.
(2) Cooking tips to reduce potassium: cook vegetables by boiling or stewing, discard soup and eat vegetables; fruits boiled in water and then discard water and eat pulp; put food in ultra-low temperature refrigeration; soak fruits in water for 1-2h and then eat.
(3) Avoid the application of Chinese and Western medicines containing high potassium.
(4) Ensure adequate dialysis.
(5) Regular blood tests for potassium level.
14.What is high blood phosphorus?
Normal blood phosphorus value is 0,80-1,60mmol/L, when it is higher than 1,60mmol/L, it is hyperphosphatemia.
15.How to avoid high blood phosphorus?
When high blood phosphorus should be given a low phosphorus diet, limiting phosphorus intake to about 600-800mg/d. A low protein diet can reduce the phosphorus intake to this range. Also can apply phosphorus binding agents such as calcium bicarbonate, aluminum hydroxide, etc., can increase the excretion of phosphorus, reduce blood phosphorus, protect the residual kidney units, and delay the progress of CRF.
16.What foods are high in phosphorus?
Foods can be divided into three categories according to the different phosphorus content.
(1) High phosphorus: 100g of food contains more than 300mg of phosphorus, commonly found in pine nuts, sesame paste, shrimp skin, canned pangasius, watermelon seeds, pumpkin seeds, mushrooms, sea fish, cashew nuts, soybeans, milk powder and milk tablets.
(2) Medium phosphorus: 10-300mg of phosphorus in 100g of food, commonly found in beef, eggs, refined rice, refined noodles, vegetables (winter melon, eggplant, tomatoes).
(3) Low phosphorus: 100g of food contains less than 10mg of phosphorus, commonly found in vermicelli, vermicelli, aquafaba sea cucumber, taro, watermelon, starch, rock sugar, vegetable oil, apples, water radish, bai lan gua, lotus root powder.
17.What is the normal calcium level?
Normal blood calcium level is between 2,12-2,65 mmol/L. When CRF < 40 ml/min, blood calcium starts to decrease and should be supplemented with calcium. The commonly used calcium supplement is calcium gluconate, which can be taken orally or injected intravenously.
18.Does calcium need to be supplemented all the time?
When the CRF is <40ml/min, the blood calcium starts to decrease and should be supplemented with calcium. However, calcium supplementation when blood phosphorus is high may cause an increase in calcium-phosphorus product and lead to tissue calcification, therefore, blood phosphorus should be controlled below 1,78mmol/L before applying calcium. The blood calcium level should be monitored during the course of medication, and calcium supplementation should be stopped when the blood calcium is >2,63mmol/L.
19.Why is it necessary to supplement vitamin D with calcium?
Low blood calcium and high blood phosphorus can be followed by hyperparathyroidism and renal osteodystrophy, both of which are related to 1,25(OH)2D3 deficiency, and the treatment with 1,25(OH)2D3 is effective. At present, the commonly used drugs are rocalciferol and alpha-D3, etc.
20.Why should patients with renal failure take sodium bicarbonate?
Most CRF patients have metabolic acidosis, so they should take sodium bicarbonate orally frequently, usually 3-10g/d in three doses. In severe acidosis, it must be given intravenously, and the dose should be adjusted according to the results of CO2-CP and blood gas analysis. Experimentally, it is proved that metabolic acidosis can damage renal tubular interstitial, and the mechanism is related to the increased production of NH4 by tubules, and sodium bicarbonate treatment can reduce the effect of this renal damage, thus protecting renal function.
21.Do all dialysis patients need anticoagulants?
The role of anticoagulants is to prevent coagulation in the extracorporeal circulation during dialysis and is given at the time of boarding. The commonly used ones are heparin sodium, sulpiride, gipeline, darbepo, etc. General dialysis patients need to use, such as the presence of bleeding gums, nasal bleeding, hematuria and other bleeding phenomena to inform the doctor in a timely manner, the need to adjust the dosage, if necessary, without anticoagulants for dialysis.
22.Why do renal failure patients need to use Ebio?
The role of recombinant human erythropoietin injection (JiVeXin, LiXinBao, YiBio, etc.) is to enhance hematocrit and correct anemia. Erythropoietin can be injected subcutaneously or administered from the intravenous end of the dialysis line after getting off the machine.
23.Why do chronic renal failure patients need iron supplements?
Iron supplements are needed for chronic renal failure patients with combined anemia, and are commonly used for oral administration of Sulforaphane, intravenous iron sucrose injection, and iron dextrose injection. Patients on dialysis can be given from the intravenous end of the dialysis line at the end of dialysis.
24.What are the benefits of levocarnitine injection?
Levocarnitine Injection is indicated for chronic renal failure long-term hemodialysis patients with a range of complication symptoms arising from carnitine deficiency in hemodialysis, such as cardiomyopathy, skeletal myopathy, cardiac arrhythmia, hyperlipidemia, as well as hypotension and muscle spasm in dialysis. This drug can be administered from the intravenous end of the dialysis line at the time of dismounting.
25.Doctors often tell kidney failure patients to have a low protein diet, how much can they eat every day?
For patients with CRF before dialysis, low protein diet is still the main diet, and it varies according to the degree of renal impairment, generally at Ccr 20~40ml/min (Scr 176,8~353,6μmol/L), the protein intake (PI) is 0,7~0,8g/(kg・d); Ccr 10~20ml/min (Scr 353,6~707 The PI is 0,6～0,7g/(kg・d) for Ccr 10～20ml/min (Scr≥707,2μmol/L) and 0,6g/(kg・d) for Ccr10ml/min (Scr≥707,2μmol/L).
26, kidney failure patients with low protein diet, why do we need to eat Kai Tong?
Patients with intermediate and advanced CRF have obvious essential amino acid deficiency, and the content of essential amino acids in ordinary dietary protein is less than 50%, which is difficult to meet the needs of patients. Supplementation with exogenous essential amino acids can correct the imbalance of essential amino acid/essential amino acid ratio in the body, thus helping to improve protein synthesis and reduce the production of nitrogen metabolites. Kaito, or alpha-keto acid (α-KA), is an amino acid precursor that can be converted to the corresponding amino acid in vivo through transamination or amination, and its efficacy is similar to that of essential amino acids, with the following advantages.
①The rate of urea nitrogen production and urea nitrogen decrease more significantly, and the ratio of protein synthesis to catabolism is increased.
②It can reduce blood phosphorus alkaline phosphatase and PTH level.
③In animal experiments, α-KA did not lead to an increase in GFR or an increase in albumin excretion.
④Delayed the progression of CRF.