genitourinary disorders
Overview of Renal Replacement Therapy
Introduction
Renal replacement therapy (RRT) replaces nonendocrine kidney function in patients with Chronic Kidney Disease and is occasionally used for some forms of poisoning. Techniques include and Vitamin D Deficiency and Dependency ) of renal failure. During dialysis, serum solute (eg, sodium, chloride, potassium, bicarbonate, calcium, magnesium, phosphate, Dialysis and filtration can be done intermittently or continuously. Continuous therapy is used almost exclusively for Acute Kidney Injury (AKI) . Continuous therapy is sometimes better tolerated than intermittent therapy in unstable patients because solute and water are removed more slowly. All forms of RRT except peritoneal dialysis require vascular access; continuous techniques require a direct arteriovenous or venovenous circuit. The choice of technique depends on multiple factors, including the primary need (eg, solute or water removal or both), underlying indication (eg, acute or chronic kidney failure, poisoning), vascular access, hemodynamic stability, availability, local expertise, and patient preference and capability (eg, for home dialysis). The table Indications and Contraindications to Common Renal Replacement Therapies lists indications and contraindications for the common forms of RRT. Medical Aspects of Long-Term Renal Replacement Therapy ideally involves a nephrologist, a psychiatrist, a social worker, a renal dietitian, dialysis nurses, a vascular surgeon (or other surgeon skilled in peritoneal dialysis catheter placement), and the transplant surgical team. Patient assessment should begin when Psychosocial evaluationis important because RRT makes patients socially and emotionally vulnerable. It interrupts routine work, school, and leisure activities; creates anger, frustration, tension, and guilt surrounding dependency; and alters body image because of reduced physical energy, loss of or change in sexual function, changed appearance due to access surgery, dialysis catheter placement, needle marks, bone disease, or other physical deterioration. Some patients react to these feelings by nonadherence or by being uncooperative with the treatment team. Personality traits that improve prognosis for successful long-term adjustment include adaptability, independence, self-control, tolerance for frustration, and optimism. Emotional stability, family encouragement, consistent treatment team support, and patient and family participation in decision-making are also important. Programs that encourage patient independence and maximal resumption of former life interests are more successful in decreasing psychosocial problems. 