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renal replacement therapy

Term used for treatment of end-stage renal disease. Treatment modalities would include: - renal dialysis - hemodialysis* - continuous renal replacement therapy (CRRT) - peritoneal dialysis* - renal transplantation - investigational wearable artificial kidney [4] * clinical outcomes are the same for peritoneal dialysis vs hemodialysis Indications: - end-stage renal disease - early renal replacement therapy of no benefit for patients with septic shock, acute respiratory distress syndrome or other critical illness [1,2] - oliguria or anuria for > 72 hours or elevated blood urea nitrogen (BUN; > 112mg/dL) [3] Management: - patient education prior to end-stage renal disease increases likelihood of - listing for renal transplant - preemptive renal transplantation - superior quality of life, improved survival, less expensive than long-term renal dialysis [1] - selection of home modality (peritoneal dialysis) [1] - mortality benefit

Related

end-stage renal disease (ESRD)

Specific

continuous renal replacement therapy (CRRT) renal dialysis renal transplantation

General

clinical procedure

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 17, 19. American College of Physicians, Philadelphia 1998, 2015, 2021 - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  2. Gaudry S, Hajage D, Schortgen F et al. Timing of renal support and outcome of septic shock and acute respiratory distress syndrome. A post hoc analysis of the AKIKI randomized clinical trial. Am J Respir Crit Care Med 2018 Jul 1; 198:58 PMID: 29351007 https://www.atsjournals.org/doi/10.1164/rccm.201706-1255OC
  3. Gaudry S et al. Comparison of two delayed strategies for renal replacement therapy initiation for severe acute kidney injury (AKIKI 2): A multicentre, open-label, randomised, controlled trial. Lancet 2021 Apr 3; 397:1293. PMID: 33812488 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00350-0/fulltext
  4. Neuman ME US issues patent for wearable artificial kidney. Helio. May 11, 2021 https://www.healio.com/news/nephrology/20210511/us-issues-patent-for-wearable-artificial-kidney