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Pediatric renal supportive therapies: the changing face of pediatric renal replacement approaches

Ari Auron1, Patrick D Brophy

  • 1Blank Children's Hospital, Des Moines, Iowa, USA.

Current Opinion in Pediatrics
|January 12, 2010
PubMed

Insights

The term "renal replacement therapy" inaccurately describes dialysis, which cannot fully replace native kidney function. A shift to "renal supportive therapy" terminology is proposed to better reflect current capabilities and encourage research.

Area of Science:

  • Nephrology
  • Renal Medicine
  • Critical Care

Background:

  • The term 'renal replacement therapy' (RRT) is widely used for dialytic interventions in acute and chronic kidney conditions.
  • Current terminology does not accurately represent the limited capacity of dialysis to replicate all native renal functions.
  • Advances in dialytic therapies have not been matched by conceptual shifts regarding the non-dialyzable aspects of kidney function.

Purpose of the Study:

  • To evaluate the adequacy of the term 'renal replacement therapy' in describing current dialytic interventions.
  • To highlight the 'nonreplaceable' aspects of native renal function in acute and chronic settings.
  • To advocate for a terminology shift that better reflects the supportive role of dialysis.

Main Methods:

  • Literature review and conceptual analysis of terminology in nephrology.
  • Comparison of historical and current terms for kidney disease and its treatment.
  • Analysis of the functional scope of dialytic therapies versus native kidney function.

Main Results:

  • The terms 'chronic kidney disease' and 'acute kidney injury' have successfully replaced older, less precise terms.
  • Dialytic therapies, while advanced, do not fully replace all functions of the native kidney.
  • Existing terminology fails to capture the extent to which dialysis supports, rather than replaces, renal function.

Conclusions:

  • A paradigm shift in understanding renal function support is needed.
  • The term 'renal replacement therapy' should be replaced with 'renal supportive therapy'.
  • Adopting 'renal supportive therapy' may stimulate scientific inquiry and improve clinical care for patients with acute and chronic kidney conditions.
Abstract

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