Renal replacement therapy Renal replacement therapy (RRT) refers to medical treatments used to replace kidney function in individuals whose kidneys are no longer able to adequately filter and remove waste products, mointain electrolyte balance, and regulate fluid levels. RRT is typically used in cases of end-stage renal disease (ESRD) or acute kidney injury (AKI) with severe renal dysfunction.

Indications for RRT: 

• Severe metabolic acidosis Hyperkalemia refractory to medical treatment. 
• Fluid overload unresponsive to diuretics. 
• Uremia causing symptoms (e.g., pericarditis, encephalopathy) 
• Toxin removal (e.g., drug overdoses). 

The choice of appropriate RRT depends on several factors: 

• Chronic vs, acute renal failure. 
• Patient’s hemodynamic stability. 
• Lifestyle and personal preferences. 
• Availability of resources and expertise. 

The main types of RAT include: 

1. Hemodialysis (HD) 

• Process: Blood is removed from the body, filtered through a dialysis machine (artificial kidney), and returned to the body. 
• Frequency: Typically done 3-5 times per week for chronic kidney failure; duration is about 4 hours per session 
• Access: Requires vascular access either through an arteriovenous (AV) fistula, graft, or central venous catheter, 
• Indications: ESRD or acute situations requiring rapid clearance of toxins.

2. Peritoneal Dialysis (PD):

• Process: Uses the lining of the peritoneal cavity (peritoneum) as a natural filter. A sterile dialysis solution is introduced into the abdominal cavity, absorbs waste products, and is then drained out. 
• Types: Continuous Ambulatory Peritoneal Dialysis (CAPD): Manual exchanges Automated Peritoneal Dialysis (APD): Performed using a machine 
• Access: Requires a peritoneal catheter inserted into the abdomen.. 
• Advantages: Can be done at home and provides greater flexibility.
• Drawbacks: Risk of infections, such as peritonitis. 

3. Kidney Transplantation:

• Process: A healthy kidney from a donor (living or deceased) is transplanted into the patient. 
• Indications: Preferred long-term solution for ESRD, offering improved quality of life and survival compared to dialysis. 
• Considerations: Requires lifelong immunosuppressive therapy to prevent rejection