Pros And Cons Of Renal Replacement Therapy
Once it is determined that renal replacement therapy will eventually be required, the patient should be counselled to consider the advantages and disadvantages of hemodialysis (in-center or at home), peritoneal dialysis (continuous or intermittent modalities), and renal transplantation (living or deceased donor) [ 35]. The 2006 K/DOQI guidelines recommend that patients with a GFR less than 30 mL/min per 1.73 m2 should be educated concerning these issues [ 29].
Kidney transplantation is the treatment of choice for end-stage renal disease. A successful kidney transplant improves the quality of life and reduces the mortality risk for most patients, when compared with maintenance dialysis. To facilitate early transplantation, a 2008 NKF/KDOQI conference suggested early education and referral to a transplantation center plus the identification of potential living donors [ 36].
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Referral to a transplant program should occur once renal replacement therapy is thought to be required within the next year [ 37].
Living donor transplants, if available, have the additional advantage of being performed with minimal delay, thereby permitting pre-emptive transplantation (transplantation prior to initiating dialysis). Such patients appear to
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