Renal replacement therapy (RRT) in patients with advanced chronic kidney disease (CKD) is considered based on several key indications NICE NG107. Advanced CKD is typically defined as an estimated glomerular filtration rate (eGFR) of less than 15 ml/min/1.73 m², which is also referred to as kidney failure (GFR category G5) NICE NG203.
Indications for initiating RRT include the impact of symptoms of uraemia on daily living, specific biochemical measures, or uncontrollable fluid overload NICE NG107. RRT may also be considered at an eGFR of around 5 to 7 ml/min/1.73 m² even if there are no symptoms NICE NG107.
Furthermore, RRT may be required for suspected complications of CKD, such as end-stage renal disease (ESRD), persistent hyperkalaemia, and persistent metabolic acidosis NICE CKS,NICE CKS. Urgent RRT may be indicated if complications like refractory severe hyperkalaemia, metabolic acidosis, uraemia, fluid overload, or pulmonary oedema do not respond to medical management NICE CKS,NICE CKS.
It is crucial that the decision to initiate dialysis is made jointly by the person (or, where appropriate, their family members or carers) and their healthcare team NICE NG107. Before starting dialysis in response to symptoms, it is important to be aware that some symptoms may be caused by non-renal conditions NICE NG107.
Key References
- NG107 - Renal replacement therapy and conservative management
- NG203 - Chronic kidney disease: assessment and management
- CKS - Kidney disease - chronic
- CKS - Chronic kidney disease
- CKS - Acute kidney injury
- CKS - Kidney injury - acute
- (Mignani et al., 2010): Dialysis and transplantation in Fabry disease: indications for enzyme replacement therapy.