RENAL REPLACEMENT THERAPY

The burden of chronic kidney disease and end stage renal failure is becoming a major problem worldwide. There are virtually no published reports on incidence, prevalence or survival of patients with kidney disease in Ethiopia but in sub-Saharan Africa 12-23% of adults are estimated to have chronic kidney disease(CKD) with the associated risk of developing end stage renal disease(ESRD) and requiring renal replacement therapy (RRT) to live.

Renal replacement therapy is a term used to refer to modalities of treatment that are used to replace the waste filtering function of a normal kidney. The primary goal of RRT is to compensate for, in part, and loss of renal function and associated sequels. These include the accumulation of nitrogenous waste products, uremic toxins, electrolyte disturbances, metabolic acidosis and volume overload.

The available modalities of renal replacement therapy include

  • Intermittent haemodialysis (most commonly used)
  • Peritoneal dialysis
  • continuous renal replacement therapy
  • kidney transplant

The Researches have noted that dialysis which is one of the most RRT used can’t compensate for all the tasks performed by kidney. And thus the term renal support therapy has been suggested to be a better name.

The principle of dialysis
Dialysis is based on semi permeable membrane used to filter out wastes in the form of solute by diffusion or convection and excessive water, in a process called ultra filtration.

The rate of ultra filtration depends upon transmembrane pressure and the membrane permeability.
 More over the diffusion of solute depends upon factors such as:
• The inter-compartment concentration gradient separated by the membrane
• Temperature
• Diffusion coefficient
• Surface area of the membrane
• Solute characteristic such as molecular weight ,protein-binding and flow rate of blood as well as ,dialysate flow

Indication for dialysis
The decision to initiate dialysis in patient with kidney failure depends on several factors. These can be divided into acute or chronic indication
Acute indication
 In a patient with acute kidney injury
• Acidemia from metabolic acidosis in situations where correction with sodium bicarbonate is impractical or may result in fluid overload
• Electrolyte abnormality such as severe hyperkalemia, especially when combined with AKI

• Intoxication, that is acute poisoning with dialyzable substances
• Overload of fluid not expected to respond to treatment with diuretics
• Uremia complication, such as pericarditis ,encephalopathy or gastro intestinal bleeding
Chronic indications
 Chronic dialysis is indicated when a patient has symptomatic kidney failure and low glomerular filtration rate (GFR<15ml/min).

Kidney transplantation
A Kidney transplant is a surgical procedure to place a healthy kidney from a living or deceased donor into a person whose kidney no longer function properly.
It is usually considered as the best choice of treatment in all patients with ESRD that do not have reasons that preclude their suitability .There is a good evidence that patients with a successful transplant have better survival rates and are less likely to be admitted to hospital and have other complications that are mutual to dialysis such as bone disease.

For the patients it’s easier to return to normal day to day function. Most importantly for ladies of child bearing age can have successful pregnancies which are almost impossible on dialysis.
The health risk associated with kidney transplant include those associated directly with the surgery itself, rejection of the donor organ and side effects of taking medications needed to prevent your body from rejecting the donated kidney

Conclusion
Patients with end stage renal failure need renal replacement therapy to stay alive. Among the different types of RRT renal transplant is the best choice of treatment but can’t be a cure. Dialysis becomes the first choice of treatment in patients with ESRD in which transplantation wouldn’t be suitable such as: underling malignancy, sever heart disease, chronic infection. Some patients are also excluded because their underlying kidney disease is likely to recur or because they have developed antibodies to foreign tissue antigens from pregnancy, transfusion or previous failed transplants.
Author: Dr. Sena Kibebew https://www.linkedin.com/in/sena-kebebew-3104a91b2 senakebebewmocha321@gmail.com

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