Chronic Renal Failure and Future Approaches
Historically the conservative treatment of chronic renal failure has been carried out with the aid of special diets which limit the intake of dietary precursors of what I shall call, for lack of a better word, “uremic substances” including cations such as potassium. In addition dietary management includes the restriction of fluids in excess of insensible and residual urinary losses. This type of management is primarily preventive. Other preventive therapeutic steps include the use of gastrointestinal sorbents like aluminum hydroxide, potassium-sequestering resins, and others such as oxystarch to bind specific undesirable uremic substances (phosphate, potassium, urea) and to carry them out via the feces. All of these preventive concepts of management of uremia must be looked upon as adjunctive modes of therapy since in patients with a residual glomerular filtration rate below 3 milliliters per minute, they alone cannot sustain life. As useful as the preventive concepts of uremic management continue to be, the mainstay of today’s therapeutic approaches to end-stage renal failure is based on the removal of undesirable uremic substances from or with body fluids — in brief, hemodialysis or peritoneal dialysis, and, more recently, hemofiltration.
KeywordsPeritoneal Dialysis Chronic Renal Failure Aluminum Hydroxide Peritoneal Lavage Future Approach
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