Organization diagnosis and treatment of renal anemia in patients receiving chronic hemodialysis program
Science Articles / / May 07, 2016
At the heart of the development of renal anemia is considered to be the traditional theory of the lack of endogenous erythropoietin.At the same time, our research system and hematopoiesis fluctuations serum iron levels in patients with chronic renal failure indicate the impact on the development and maintenance of renal anemia three groups of factors that form the basis of its theory of the origin.By the force of impact on the behavior of the system hematopoiesis main factors of metabolic theory of renal anemia are presented in the following form:
- violation of protein-energy metabolism;
- violation of intracellular ferroproteinov;
- lack of synthesis of endogenous erythropoietin.
additional factor leading to an increase in the severity of anemia in patients treated by chronic hemodialysis program is chronic blood loss during hemodialysis.
is well known that the growth of azotemia associated with a decrease in the mass of active nephrons, accompanied by a decrease in hemoglobin.
- treatment of intercurrent diseases;
- stabilization of protein and energy metabolism;
- replacement therapy with recombinant erythropoietin;
- timely initiation of hemodialysis therapy.
At the same time, our research indicates that the use of "re-Hughes," using dialyzers more than 4-5 times the hemoglobin figures should not exceed 100 g / l.This is due to the fact that an increase in hemoglobin content of more than 100 g / l of dialysis quality decreases by 2-2.5 times due to capillary thrombosis part dialyzer.This fact contributes to the deterioration of the patient and the deterioration of health.At the same time when the hemoglobin numbers from 95 to 100 g / l, if there are no other diseases, patients are able to perform physical work of moderate severity, to actively participate in everyday life, and indicators of quality of life does not suffer.
Organization of treatment with recombinant erythropoietin.Initiation of therapy practiced at a hemoglobin level less than 90 g / l.The starting dose - 50-150 IU / (kg / week).This dose is divided into 2-3 times a week.The target level of hemoglobin (95-100 g / l) is achieved after 8-12 weeks.Then, the dose is reduced by 2-3 times.With an increase in hemoglobin of 110 g / l erythropoietin overturned.The most frequent complications of the use of erythropoietin - hypertension, thrombosis and the bloodstream dialyzers, vascular access site.In the event of the above complications erythropoietin overturned.