Non-Dialysis Therapies for Uremia

Although dialysis and kidney transplantation are highly effective treatments for chronic renal failure, only 10-20% of uremia patients in China currently have access to these therapies. The remaining 80-90% rely on non-dialysis treatments, which include the following approaches:

1. Maintaining Water-Electrolyte Balance & Correcting Acidosis

• Fluid & salt intake adjustment: Low-salt diet recommended.
• Hyperkalemia prevention: Use ion-exchange resins for high potassium; IV 10% calcium gluconate (10mL) or glucose + insulin if needed; dialysis in severe cases.
• Acidosis correction: Oral sodium bicarbonate; IV infusion if necessary.
• Calcium-phosphorus regulation: Limit phosphorus intake, supplement calcium (1.5–2g/day), and administer active vitamin D3 (0.25–0.5μg/day).

2. Nutritional Therapy

• Adequate caloric intake + low-protein diet (LPD, 0.5–0.75g/kg/day) to slow renal decline (avoid if severe complications exist).
  • 65–75% high-quality animal protein; restrict plant protein.
  • Supplement with essential amino acids (oral/IV) or α-ketoacid (e.g., Ketosteril®) to reduce BUN, phosphorus, and acidosis.

3. Anemia Management

• Recombinant erythropoietin (EPO): Subcutaneous injection, 3,000 units 2–3x weekly.

4. Integrative Chinese-Western Medicine

• Herbal therapies: Focus on rhubarb (Rheum palmatum) or tailored formulas based on TCM diagnosis.

5. Gastrointestinal Dialysis

• Oral adsorbents (e.g., coated aldehyde oxystarch) or oral dialysis solutions to lower BUN/SCr and alleviate symptoms.

6. Hypertension Control

• Crucial to delay kidney damage and prevent complications (e.g., heart failure, stroke).
• Methods:
  • Low-salt diet.
  • Diuretics (often limited efficacy).
  • Antihypertensives: Calcium channel blockers (e.g., Nifedipine, Amlodipine) or ACE inhibitors (e.g., Benazepril, Fosinopril).

Conclusion

Non-dialysis therapies are effective in early-stage renal failure but offer limited benefits for advanced uremia. Dialysis or transplantation remains optimal when accessible.