Renal dialysis

Severe renal failure, for example a creatinine clearance of less than 5 ml per minute, is most easily managed by dialysis.

In patients with a rapidly-developing uraemia, dialysis provides time for the underlying pathology to be fully investigated. This extra time may be particularly important when renal imaging shows normal-sized kidneys, implying recent onset of renal disease.

The criteria for accepting patients for long-term dialysis vary from centre to centre. In the U.K. 60-80 per million of the population per year are accepted.

Dialysis may be achieved by:

• haemodialysis and haemofiltration
• peritoneal dialysis

Notes:

• renal replacement therapy (RRT) is a treatment option in people with CKD whose condition progresses to kidney failure
  • RRT essentially comprises either transplantation or dialysis
    
    
• according to the 19th annual report by the UK Renal Registry (2016), on 31 December 2015 there were 61,256 adults in the UK receiving RRT
  • of these, 53.1% had received a transplant, 41.0% were receiving haemodialysis (21.2% in satellite units, 17.8% in hospitals, 2.0% at home), 2.5% were receiving continuous ambulatory peritoneal dialysis and 3.4% were receiving automated peritoneal dialysis
  • in addition, 769 children and young people under the age of 16 years were receiving RRT
    • most had received a transplant (41% live, 34% deceased), with 13% on haemodialysis and 12% on peritoneal dialysis
  • median age of all people newly requiring RRT was 59.0 years; 22.7% of people were from minority ethnic groups

Reference:

• NICE (October 2018). Renal replacement therapy and conservative management