Dialysis and Renal Replacement Therapy (RRT) Study Guide: Types, Indications, and Management

This comprehensive study guide provides essential information on Dialysis and Renal Replacement Therapy (RRT), including the indications for dialysis, types of dialysis, and how to manage patients with chronic kidney disease (CKD) or acute kidney injury (AKI). It is a valuable resource for healthcare professionals, medical students, or anyone looking to understand the process and considerations surrounding renal replacement therapies.
 
Key Features:
What is Dialysis? Learn about dialysis as a form of renal replacement therapy that removes waste products, toxins, and excess fluids from the blood when kidneys can no longer perform these functions effectively.
Indications for Dialysis: Discover when dialysis is indicated, including an eGFR < 20 mL/min/1.73m², and how early referral to an Advanced Kidney Care (AKC) clinic helps plan RRT and slow the progression of CKD.
 
Types of Dialysis:
Haemodialysis (HD): A common method that uses a machine to filter the blood. It is typically performed 3 times a week.
Peritoneal Dialysis (PD): Uses the peritoneum as a natural filter and is performed by the patient at home with manual or machine-assisted dialysis (CAPD/APD).
Continuous Renal Replacement Therapy (CRRT): Used in critically ill patients, CRRT offers a gentler, more continuous filtration process.
 
Renal Transplant: The preferred option for eligible patients.
Dialysis Goals: Understand the key goals of dialysis, including removal of uremic toxins, control of blood pressure and fluid overload, maintenance of electrolyte balance, and improved quality of life.
When to Start RRT: Learn the criteria for starting dialysis in both chronic (eGFR < 10) and acute settings (e.g., severe metabolic acidosis, hyperkalemia, or anuric AKI).
 
Haemodialysis (HD) and Haemodiafiltration (HDF): Explore the mechanisms of HD and HDF, including passive diffusion, ultrafiltration, and convection, and how they help remove toxins and excess fluids from the blood.
Peritoneal Dialysis (PD): Understand the process of PD, including how glucose-containing dialysate is used to filter waste products and remove excess fluids via the peritoneal cavity.
Vascular Access for HD: Learn about the different types of vascular access for haemodialysis, including arteriovenous (AV) fistulas, grafts, and central venous catheters.
 
Dialysis Complications: Review common complications of both haemodialysis and peritoneal dialysis, such as hypotension, occluded lines, infections (e.g., peritonitis), and fluid overload.
Anticoagulation in Dialysis: Understand the role of anticoagulation in preventing clotting in dialysis circuits and the use of low molecular weight heparin (LMWH).
Medications in Dialysis: Learn about medications commonly prescribed during dialysis, including anticoagulants, erythropoiesis-stimulating agents (ESAs), IV iron, phosphate binders, and calcimimetics.
 
Nutrition for Dialysis Patients: Explore dietary considerations for dialysis patients, including fluid retention control, low potassium and phosphate intake, and the role of dietitians in managing nutritional needs.
Whether you’re preparing for exams, managing dialysis patients in clinical practice, or looking to understand renal replacement therapy, this guide offers a detailed and structured approach to dialysis, patient management, and RRT.