Renal replacement therapy: current modalities, indications, and clinical considerations

Chronic kidney disease (CKD) is a significant global health issue, affecting ~10% of the world's population. In the USA, nearly 90% of adults with CKD are unaware of their condition, leading to delays in care and, in many cases, progression to end-stage kidney disease (ESKD) requiring renal replacement therapy (RRT). It is important to recognize that not all individuals with CKD will develop kidney failure. RRT options include hemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation. Prior to initiating HD, a vascular access such as an arteriovenous (AV) fistula, AV graft, or central venous catheter, must be placed, typically by a vascular surgeon. In contrast, PD requires a surgically implanted catheter in the abdomen. This paper reviews the available RRT modalities and emphasizes the importance of offering conservative management as an alternative approach. Additionally, we explore emerging innovations such as wearable and portable HD devices, that have the potential to transform ESKD care and significantly improve patients' quality of life.