Renal replacement therapy





Introduction

Chronic kidney disease (CKD) is a relatively common condition, affecting 1 in 8 people in the UK. Around 10% of those with CKD will go on to develop renal failure, which is defined as a glomerular filtration rate of less than 15ml/min. For patients with renal failure, the management options are renal replacement therapy (RRT), to take over the physiology of the kidneys, or conservative management, which will be palliative.

There are several types of renal replacement therapy available to patients:

The decision about which RRT option to pick should be made jointly by the patient and their healthcare team, taking into account the following:
  • predicted quality of life
  • predicted life expectancy
  • patient preference
  • co-existing medical conditions

Complications

Complications of renal replacement therapy

HaemodialysisPeritoneal dialysisRenal transplantation
Site infectionPeritonitisDVT / PE
EndocarditisSclerosing peritonitisOpportunistic infection
Stenosis at siteCatheter infectionMalignancies (particularly lymphoma and skin cancer)
HypotensionCatheter blockageBone marrow suppression
Cardiac arrhythmiaConstipationRecurrence of original disease
Air embolusFluid retentionUrinary tract obstruction
Anaphylactic reaction to sterilising agentsHyperglycaemiaCardiovascular disease
Disequilibration syndromeHerniasGraft rejection
Back pain
Malnutrition

TYPES

Haemodialysis
Peritoneal dialysis
Renal transplantation