Dialysis procedure for people with diabetes: Things to pay attention to

The article was professionally consulted by Specialist Doctor I Tran Quoc Vinh - Emergency Doctor - Department of Resuscitation - Emergency - Vinmec Nha Trang International General Hospital.
Diabetic nephropathy refers to patients with diabetes with impaired renal structure or function and/or glomerular filtration rate less than 60 ml/min/1.73 m2. Renal failure is a common diabetic complication in about 30% of cases. Therefore, when having indications for dialysis for people with diabetes, certain precautions should be taken.

1. Why does diabetes cause kidney damage?

In patients with diabetes, blood glucose levels rise beyond the body's control (usually greater than 10.0 mmol/L), the body's physiological response compensates by excreting glucose through the kidneys, leading to increased blood flow to the kidneys. too large causes the kidneys to overwork. Prolonged overactivity in the kidneys will cause the filtration system to begin to be destroyed, the filter holes become larger, allowing more protein to escape. At this time, abnormalities can be detected through proteinuria, even if only a small amount, if treated, it will help limit the decline in kidney function.
In the late stages, the kidney damage becomes more and more severe, more proteinuria is excreted in the urine, and kidney function gradually declines, eventually kidney failure. At this time, the concentration of toxic substances in the body such as urea, creatinine increases very high due to the renal elimination function is severely impaired, besides, the amount of water is also reduced, leading to edema and overload. fluid, causing heart failure, acute hemodynamic pulmonary edema, life-threatening, requiring treatment with dialysis to remove toxins as well as excess water.
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2. Is dialysis common for people with diabetes?

In fact, there are about 20-40% of new patients on dialysis every year in Vietnam, of which diabetics on dialysis are increasing year by year. However, the indication for dialysis for diabetic patients is unavoidable because the mortality rate of diabetic patients requiring dialysis is much higher than that of non-dialysis patients. The cause of death is usually cardiovascular complications and infections.

3. When is dialysis indicated for diabetics?

Diabetics will be indicated for dialysis in some of the following cases:
The glomerular filtration rate is less than 15 ml/min/1.73 m2, usually when < 10 ml/min/1.73 m2. Indicated early in patients with complications such as cardiovascular disease, malnutrition, high blood urea nitrogen syndrome, excess salt and water, electrolyte disturbances... Besides, contraindications of dialysis for patients with urine Sugar is similar to people without diabetes. For hemodialysis, it is contraindicated in the following cases:
Patients with severe cardiovascular diseases that are prone to hemodynamic disturbances when undergoing dialysis Patients in a state of shock, cardiovascular collapse Patients with Acute myocardial infarction, severe arrhythmia Patients with coagulopathy, do not use heparin Patients with terminal cancer Patients cannot make arteriovenous bridges. However, it is possible to consider replacing the routine hemodialysis with continuous hemodialysis in hemodynamically disturbed cases, considering not using heparin, or replacing heparin with citrate in cases of coagulopathy.
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For hemodialysis by peritoneal dialysis should be contraindicated:
Patient has peritoneal infection Adhesed peritoneum due to old incision or old trauma Peritoneal fibrosis, intra-abdominal tumor Diaphragmatic hernia, drainage Abdominal or inguinal hernia Patients with severe COPD Patient inability to comply with technical procedures.

4. Blood purification methods for people with diabetes

There are three commonly used methods of dialysis for diabetics, including:
Artificial kidney: very effective for monitoring and treating complications but poorly tolerated in patients with cardiovascular disease or low blood pressure, as well as risk of hypoglycemia and hyperkalemia between 2 dialysis sessions Continuous outpatient peritoneal dialysis: better tolerability in patients with cardiovascular disease and no need for an arteriovenous bridging, good control of serum potassium and risk of hypoglycemia low blood pressure but can cause peritonitis, infection, or increased intra-abdominal pressure Automatic peritoneal dialysis: relatively similar to outpatient continuous peritoneal dialysis but more suitable for the visually impaired and low risk of peritonitis than.
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5. How to reduce complications in dialysis in people with diabetes

Diabetics need to do the following to reduce dialysis complications:
Complete dialysis Build a reasonable diet, control blood sugar and good blood potassium Treat hypertension and heart complications Vascular Treatment of eye diseases in diabetic dialysis patients Treatment of bone and joint diseases Treatment of anemia Vinmec International General Hospital is a high-quality medical facility in Vietnam with a team of qualified doctors and nurses. Highly qualified, well-trained, domestic and foreign, rich in experience.
A system of modern and advanced medical equipment, possessing many of the best machines in the world, helping to detect many difficult and dangerous diseases in a short time, supporting the diagnosis and treatment of doctors the most effective. The hospital space is designed according to 5-star hotel standards, giving patients comfort, friendliness and peace of mind.

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