RENAL HYDROTHERAPY
Although dialysis has been considered as a life-saving treatment in the setting of end-stage renal diseases (ESRD), there were considerable doubt concerns between the benefits of relieving advanced uremia and the inherent dangers relating to dialysis therapy itself.
Therefore, decreasing dialysis frequency and seeking for Alternative Renal Replacement Methods is not equal to the old wine in a new bottle.
The major skin disorders in end-stage renal diseases (ESRD) are xerosis, pruritus, hyperpigmentation, perforating and calcifying manifestations, and bullous diseases.
Nearly 50–100% of the ESRD patients present with at least one skin lesion. Sometimes these symptoms can be the first clear sign of chronic kidney diseases (CKD). Severe pruritus not only affects the quality of life in patients with chronic renal failure (CRF), but is also associated with poor prognosis in these subjects.
The HERBAL MEDICINAL formulas are used usually include diuretics combined with herbs with the role of reducing inflammation and protecting the kidney.
- Sweat fluid mainly contains sodium chloride, potassium, nitrogen metabolites such as urea, ammonia, uric acid, and creatinine.
- Urea is the major nitrogen-containing metabolic product of protein catabolism, accounting for about 75% of the nonprotein nitrogen eventually excreted.
- The mean sweat fluid urea concentration could reach 5.5 to 50 times the serum concentration; therefore, urea excretion via sweating is important when the renal function is impaired.
- After one to two hours’ sauna bath, the patient’s body weight decreased by 1.5–2 kg.
- The presence of a high concentration of urea in sweat fluid suggested an alternative transport mechanism to clear the blood urea across the eccrine sweat gland.
- Sweat fluid mainly contains sodium chloride, potassium, nitrogen metabolites such as urea, ammonia, uric acid, and creatinine.
- Urea is the major nitrogen-containing metabolic product of protein catabolism, accounting for about 75% of the nonprotein nitrogen eventually excreted.
- The mean sweat fluid urea concentration could reach 5.5 to 50 times the serum concentration; therefore, urea excretion via sweating is important when the renal function is impaired.
- After one to two hours’ sauna bath, the patient’s body weight decreased by 1.5–2 kg.
- The presence of a high concentration of urea in sweat fluid suggested an alternative transport mechanism to clear the blood urea across the eccrine sweat gland.
- Sweat fluid mainly contains sodium chloride, potassium, nitrogen metabolites such as urea, ammonia, uric acid, and creatinine.
- Urea is the major nitrogen-containing metabolic product of protein catabolism, accounting for about 75% of the nonprotein nitrogen eventually excreted.
- The mean sweat fluid urea concentration could reach 5.5 to 50 times the serum concentration; therefore, urea excretion via sweating is important when the renal function is impaired.
- After one to two hours’ sauna bath, the patient’s body weight decreased by 1.5–2 kg.
- The presence of a high concentration of urea in sweat fluid suggested an alternative transport mechanism to clear the blood urea across the eccrine sweat gland.
- A 30-minute hot water bath every day was as effective as a two-hour sauna bath three times a week. Sweat rates in sauna and hot water baths were 21 and 33 mL/min, respectively. Urea clearance in hot (42 °C) water baths were higher than in sauna baths, which were 56 and 40 mL/min, respectively. Calculated losses of urea and potassium in sweat fluid were 43 and 12 mmol/h compared with 117 and 20 mmol/h by hemodialysis. These findings indicated that hot bath can be used as a valuable adjunct to chronic intermittent hemodialysis.
SPECIFIC SYMPTOMS OF CRF THAT CAN BE RELIEVED BY HOT BATHS
Hot baths can reduce mean interdialytic weight gain and improve blood pressure and potassium/urea balance in patients with ESRD. Therefore, a hot bath can increase the sufficiency of dialysis and reduce the fluctuation of blood pressure and cardiovascular events in the predialysis period.
Sauna baths are used as a method of depuration protocols because they increase sweating, which might increase the excretion of impurities, such as uremic toxicity, excrescent water, and heavy metals.
THE ROLE OF HERBAL MEDICINES IN THE TREATMENT OF Chronic Renal Failure
HERBAL MEDICINES can delay the progression of CRF by ameliorating the podocyte injury, nephrotoxicity of proteinuria, hyperactivity of renin–angiotensin–aldosterone system, cytokines overexpression, tubular epithelial myofibroblast transdifferentiation, and hyperlipidemia.
HERBAL MEDICINES can ameliorate glomerulosclerosis and renal interstitial fibrosis during the progression of CRF by improving glomerular hemodynamics turbulence, podocyte injury, transforming growth factor (TGF)-beta overexpression, hyperlipidemia, macrophage infiltration, and tubular epithelial myofibroblast transdifferentiation. For the patients with CKD stage 3.
HERBAL MEDICINES can improve estimated glomerular filtration rate (eGFR) and hemoglobin with lower side effects.
Some HERBAL MEDICINES, including Astragalus and a mixture of Astragalus plus Angelica, Ligusticum, Triptolide, and Rhubarb, show benefits in slowing the progression of CKD.
HERBAL MEDICINES MEDIATED HOT BATH FOR THE TREATMENT OF CHRONIC RENAL FAILURE
By adding some decoction of HERBAL MEDICINES into warm water for bath, mediated bath is a traditional external treatment of CRF. The heat effect and absorption of active components of herbal medicine are the major reason for the curative effects.
The components of HERBAL MEDICINES for mediated bath are built according to the differentiation of symptoms and signs.
HERBAL MEDICINES with the function of promoting blood circulation such as rhizoma Chuanxiong and radix Angelicae are formulated for bath with three to four times as large as those for oral administration.
Ligustici Chuanxiong Rhizoma ether extracts exhibited an effect on the skin permeability of moderately lipophilic compounds owing to their accumulative property.
Hot baths appear to be a safe way to reduce interdialytic weight gain in selected hemodialysis patients.
CONCLUSION
HERBAL MEDICINES – mediated hot bath can dehydrate and clear uremic toxins by skin eccrine sweating in patients with chronic renal failure, decrease their skin complications and frequencies of adverse events (cardiovascular events, infection, or complications of dialysis). Therefore, it offers an adjuvant alternative renal replacement method for these subjects to reduce the frequency of dialysis due to its complications.