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CZECH MEDICAL ASSOCIATION J. Ev. PURKYNĚ |
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Česky / Czech version | Vnitřní lékařství, 49, 2003, č. 5, s. 424 - 429 |
Haemodialysis in the Treatment of Chronic Renal Failure.
Contemporary State Opatrný K. Jr., Opatrná S. I. interní klinika Lékařské fakulty UK a FN, Plzeň, přednosta prof. MUDr. Karel Opatrný, Jr., DrSc. |
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Summary: In advanced countries haemodialysis treatment is available to all patients with chronic renal
failure who need it. At present nephrologists must resolve the problem when it is possible to
withold long-term haemodialysis treatment, or withdraw it because it no longer leads to prolongation
of a good quality life. The results of long-term dialysis treatment depend on the correct
timing of its initiation and the quality of nephrological care provided already a long time before
the development of renal failure. The morbidity, mortality and quality of life of the patients are
influenced in a fundamental way by the quality of provided haemodialysis. An important factor is
the dose of dialysis treatment evaluated according to index Kt/Vurea reflecting the urea elimination
and obviously also the elimination of other low molecular weight substances. Although prospective
controlled trials did not prove so far a favourable effect of haemodialysis membranes
permeable for larger molecules ("high-flux" membranes) on the patients´ fate, the possible toxic
effect of so-called middle molecule substances and peptides with a low molecular weight is assumed.
Data suggesting improvement of the quality of life of patients having daily haemodialyses
call for further investigations. A still unresolved problem of contemporary haemodialysis systems
remains inadequate biocompatibility which leads to reactions associated with possible acute and
long-term damage of dialyzed patients.
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