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Uremia and Azotemia

When kidney function (renal perfusion, filtration, and elimination of the body’s metabolic wastes) deteriorates due to diabetes, hypovolemia, urinary tract obstruction, or other causes, the normally filtered waste products, urea, amino acids, creatinine, and other nitrates remain unfiltered and in the blood.

Elevated urea levels that aren’t high enough to cause symptoms are called azotemia.  Uremia is an elevation of urea in the blood that is high enough to cause symptoms, i.e., the “uremic syndrome.”

Signs and symptoms of uremia are fatigue, nausea, muscle wasting, tremors, cognitive changes, and these are used to make the decision for the proper time to initiate dialysis. Chronic kidney disease (CKD) is a gradual process that ultimately ends in end-stage renal disease (ESRD). The symptom continuum that begins when azotemia progresses to uremia is unique to each patient, and the decision to initiate dialysis is also an individualized decision based on physician recommendation and patient preference.

Unless there are uremic heart or lung complications or cognitive changes which make dialysis mandatory, it is otherwise a difficult decision because it means a life-long therapeutic process that is time-consuming to the point of severely affecting one’s day-to-day activities of daily living and quality of life.

Process of Dialysis

There are two types of dialysis:

  • Hemodialysis: a direct access to blood via a surgically implanted shunt or created arteriovenous fistula. It is typically done at a dialysis center where blood is pumped from the body, filtered by a machine, and then replaced. It is usually three times a week, each session taking 3-5 hours.
  • Peritoneal dialysis: Uses an abdominal catheter and can be done by the patient at home and while traveling. A fluid that is instilled, when drained back out, will have metabolic wastes and excess salt and water drain with it. The collection of fluid in the abdomen, giving the symptom of bloating, is called a “dwell,” and the recycling of new fluid for used fluid is called an “exchange.” Peritoneal dialysis can be done all the time, as “continuous ambulatory peritoneal dialysis (CAPD) with manual discarding and refilling during the day and leaving the “dwell” overnight; or just overnight in a continuous cycling peritoneal dialysis (CCPD) done by a machine.

 

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This information is provided by Vascular Health Clinics and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition.

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