UNDOUBTEDLY the most important factors in the treatment of both acute and chronic uremia are the proper regulation of diet and maintenance of water and electrolyte balance. Too often the presence of anuria or oliguria encourages the administration of large quantities of fluids in vain attempts to initiate diuresis, resulting in an overload of salt and water and the appearance of symptoms erroneously attributed to uremia.41
Where dietary treatment, including rigid control of water and electrolytes, has been ineffective the use of one of the following methods should be considered: 1. artificial kidney, 2. peritoneal dialysis, 3. intestinal dialysis, 4. replacement transfusion. The first of these will be discussed herein.
Principles of the Artificial Kidney
Regardless of the type of artificial kidney used the patient's blood must be rendered incoagulable by the injection of heparin. The blood is then guided along a cellophane membrane on the other side of which is the rinsing fluid. By the process of dialysis a large part of the abnormally retained products of metabolism — urea, uric acid, creatinine, substances giving the xanthoprotein reaction such as phenols,58 indoxyl, etc. pass from the blood through the cellophane membrane into the rinsing fluid. They become so diluted that return dialysis is negligible. In addition to this process an exchange takes place between the necessary electrolytes of the blood plasma water and those in the rinsing fluid. Hence, if the patient's blood electrolyte pattern is abnormal before treatment, it will tend to be corrected as it approaches the composition. . .