Wiki Chronic kidney disease

Indications for renal replacement therapy

Renal replacement therapy (RRT) is a life-saving treatment used to replace the function of failed kidneys. It includes modalities like dialysis (hemodialysis or peritoneal dialysis) and kidney transplantation. Here are the main indications for starting renal replacement therapy:

Indications for Renal Replacement Therapy (RRT)
1. Severe Acute Kidney Injury (AKI)
When kidney function declines rapidly and:

Persistent hyperkalemia (high potassium levels) unresponsive to medical treatment.

Severe metabolic acidosis refractory to medical management.

Volume overload causing pulmonary edema or refractory to diuretics.

Uremic symptoms such as pericarditis, encephalopathy, or bleeding.

Oliguria or anuria with rising toxins and fluid imbalance.

2. End-Stage Renal Disease (ESRD) / Chronic Kidney Disease (CKD) Stage 5
When glomerular filtration rate (GFR) falls below ~10–15 mL/min (varies by patient).

Symptoms or complications from uremia (fatigue, nausea, pruritus).

Fluid overload or electrolyte imbalances not controlled medically.

Preparation for or post kidney transplantation.

3. Certain Poisonings or Overdoses
Removal of toxins (e.g., lithium, methanol, ethylene glycol) via dialysis.

Summary Table of Common Indications:
Indication Description
Hyperkalemia Dangerous high potassium levels
Metabolic acidosis Severe acid-base imbalance
Fluid overload Pulmonary edema or resistant volume overload
Uremic symptoms Encephalopathy, pericarditis, bleeding
Oliguria/Anuria Severely reduced or absent urine output
ESRD (GFR <10-15 mL/min) Chronic kidney failure requiring support
Toxin removal Certain poisonings or drug overdoses

Would you like to know more about specific dialysis modalities or timing considerations for starting RRT?

Choosing between dialysis and kidney transplantation is a major decision for patients with end-stage kidney disease (ESKD). Here’s a clear overview of the key factors, benefits, and considerations for each option:

Dialysis vs. Kidney Transplantation: Key Points
Aspect Dialysis Kidney Transplantation
What it is A treatment that filters waste and excess fluids from the blood when kidneys fail. Includes hemodialysis (in-center or home) and peritoneal dialysis. Surgical placement of a healthy donor kidney to replace lost kidney function.
Effect on Quality of Life Often time-consuming (several hours, multiple times a week), can cause fatigue and lifestyle restrictions. Usually improves quality of life significantly compared to dialysis; more freedom and energy.
Life Expectancy Generally shorter compared to transplantation, but varies widely with individual health and dialysis type. Often results in longer survival and better health outcomes than dialysis.
Risks Infection, cardiovascular complications, vascular access issues, dialysis-related symptoms. Surgical risks, rejection, need for lifelong immunosuppressive medication with side effects.
Suitability Suitable for all patients including those who are not transplant candidates due to age, other health problems, or personal choice. Best for eligible patients with suitable health and no contraindications; requires donor availability.
Availability Readily available; can start quickly once kidney failure is diagnosed. Dependent on donor availability; waiting lists can be long.
Cost Ongoing treatment costs, often covered by insurance or public health. High upfront surgical cost, followed by medication and monitoring costs; often cost-effective long term.
Lifestyle Considerations Regular visits to dialysis centers (unless home dialysis), dietary and fluid restrictions. Fewer restrictions; requires medication adherence and regular follow-up.

Factors to Consider When Choosing
Medical Eligibility: Some patients may not be good candidates for transplantation due to other medical conditions.

Age and Overall Health: Older patients or those with serious comorbidities might benefit from dialysis if transplant risks are high.

Waiting Time and Donor Availability: Transplant may require waiting, sometimes years, depending on organ matching.

Patient Preferences and Lifestyle: Personal values, willingness to undergo surgery, and lifestyle impact are important.

Support System: Both options require support, but transplant patients especially need help with medication adherence and follow-up.

Psychological Impact: Both treatments have mental health considerations, including coping with chronic illness or post-transplant stress.

Summary
Dialysis Kidney Transplantation
Life-sustaining treatment without surgery Potentially curative, restores near-normal kidney function
More restrictions and frequent treatment visits Greater freedom and improved quality of life
Shorter average survival than transplant Longer survival and fewer complications long-term

If you want, I can help explain specific dialysis types or transplantation eligibility criteria to help you make an informed decision.

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