Renal Replacement Therapy (RRT) is a structured treatment plan for patients suffering from severe kidney failure.

When the kidneys no longer work effectively, waste and fluid builds up in the blood. Renal replacement therapy helps failing kidneys remove fluid and waste. In order to receive RRT, a patient is connected to a dialysis machine using a surgically created path called vascular access (VA) allowing blood to be removed from the body, circulated through a dialysis machine, and then return to the body.

Dialysis Catheter Placement

Most dialysis catheter placement procedures can be performed on an outpatient basis under local anesthesia. The anesthesiologist may administer some sedative medication to allow the patient to be relaxed and drowsy, but general anesthesia is usually not required. There are several different types of vascular access as follows:

  • Arteriovenous (AV) Fistula Catheter The best type of access, called an arteriovenous (AV) fistula, is surgically created between an artery and a vein in the lower arm and needs to be placed two to four months before it can be used for dialysis.
  • Arteriovenous Graft Catheter If construction of an AV fistula is not possible, a plastic tube, called a graft, can be used to create a path and can be used two weeks after placement.
  • Venous Catheter (VA) A third type of access, a central venous line, can be placed (usually in the upper chest) and can be used immediately; however, it is more prone to complications than the other types of access and should only be used if no other route is available.

Types of Renal Replacement Therapy

  • Hemodialysis During Hemodialysis Therapy, a patient’s blood is pumped through a dialysis machine to remove waste products and excess fluid. The machine works by putting the patient’s blood in contact with a special solution (dialysate) that moves impurities from the blood to the dialysate solution. Because every patient has specific needs, the number of weekly treatments will vary and can be performed at home allowing patients to continue working.
  • Peritoneal Dialysis Like Hemodialysis, Peritoneal Dialysis uses dialysate to remove impurities from the blood; however there are a few differences that make peritoneal dialysis unique. Instead of continuously filtering blood with dialysate, it is infused into the abdomen near the belly button and held within the abdomen for a prescribed period of time (called a dwell). During each cycle, (often called an exchange or cycler) the dialysate in the abdomen is drained out and discarded. The peritoneal cavity is then filled again with fresh dialysate. Patients that qualify for peritoneal dialysis have several treatment schedules to choose from based upon lifestyle or personal issues as follows:
    • Continuous Ambulatory Peritoneal Dialysis (CAPD) involves multiple exchanges during the day with an overnight dwell. The dialysate is infused into the abdomen at bedtime and is drained upon awakening.
    • Continuous Cycler Peritoneal Dialysis (CCPD) is an automated form of therapy in which a machine performs exchanges while the patient sleeps; there may be a long daytime dwell, and occasionally a manual daytime exchange is performed.
  • Kidney Transplantation Kidney Transplantation is considered the treatment of choice for many patients with severe chronic kidney disease because quality of life and survival are often improved, compared to patients who use dialysis. However, there is a shortage of organs available for donation, so many patients who are candidates for transplantation are put on a transplant waiting list and require other forms of renal replacement therapy until an organ is available. Some patients with renal failure are not candidates for a kidney transplant. Old age and severe heart or vascular disease may mean that it is safer to remain on dialysis rather than undergo kidney transplantation.