Renal Replacement Therapy

Acute kidney injury (AKI) is defined as an abrupt decrease in kidney function, with the most severe form requiring some method of renal replacement therapy (RRT). RRT is also sometimes required in patients with severe AKI as a temporary measure.

End-stage renal disease (ESRD) is a term that describes a permanent drop in renal function significant enough to indicate a need for either a kidney transplant or chronic use of RRT. RRT can be administered in multiple ways, personalized to the needs of the patient, such as intermittent hemodialysis or continuous RRT.

In addition to understanding indications for RRT and the methodology for its administration, it is important to understand the pros and cons of various types of RRT in order to best meet the needs of patients. Additionally, understanding modes of access and the details of receiving a kidney transplant will help guide management and counseling of patients with severe AKI or ESRD. For example, in a patient expected to require long-term dialysis, introduction of midline or peripherally inserted central catheters may be ill-advised, as they may preclude placement of an AV fistula down the line.