End-stage renal disease

The aims of RRT are not simply correction of blood abnormalities and maintenance of fluid balance. Patients can live on RRT for decades so the aims are for them to live as normal a life as possible. It is important that they adopt a mode of RRT that they tolerate and comply with, that provides physical well-being, and allows social and employment rehabilitation. There are now many options for the treatment of ESRD (Box 19.1).


Patients with ESRD can now expect a reasonable survival and quality of life on dialysis. The 2010 UK renal registry report shows that the annual survival rate for patients younger than 65 years old is 92 per cent. For patients who can use any modality, the choice of HD or PD will depend on individual patient preference, nephrologist bias, and local resources. Approximately 28 per cent of patients younger than 65 years old start PD in the UK but this can vary between hospitals in the same city. Dialysis affects all aspects of life including work, diet, family life, holidays, and travel. From the patient’s perspective, perceived quality of life is the principal reason for choosing

Box 19.1 Treatment modalities for ESRD

  • ? Haemodialysis (HD)
  • • Centre
  • • Satellite
  • • Home
  • ? Peritoneal dialysis (PD)
  • • CAPD (continuous ambulatory PD)
  • • APD (automated PD)
  • ? Transplantation
  • • Cadaver
  • • Living donor (related or unrelated)
  • ? Conservative management
  • ? Best supportive care

between dialysis modalities. As shown in Box 19.2, the main differences between PD and HD arise because PD is a home-based treatment and HD (with few exceptions) is a hospital-based treatment.

A study of patients commencing dialysis in the Netherlands showed that of the 864 patients who chose their dialysis modality, 36 per cent starting PD were employed as compared with

Box 19.2 Quality of life and modality of dialysis

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