Options for renal replacement therapy: special considerations

The number of patients coming to end-stage renal disease (ESRD) continues to increase annually, challenging the existing system of renal replacement therapy. Moreover, these patients, on average, are older at the onset of ESRD and are living longer after the initiation of renal replacement therapy. The choice of modality of renal replacement therapy (hemodialysis, peritoneal dialysis, or transplantation) that is best suited for a particular patient is thus increasingly important. Important factors to consider include not only mortality and morbidity, but also quality of life, patient age and social circumstances, and the etiology of ESRD. Three ESRD patient populations in particular, diabetic patients, the elderly and the patients with HIV infection or acquired immunodeficiency syndrome (AIDS), present renal care providers with complex issues as to renal replacement therapy and outcomes. Motivated patients with available resources, no matter what their cause of ESRD, should be considered as excellent candidates for home hemodialysis. This modality of renal replacement therapy is associated with improved survival and quality of life when compared with other modes of dialysis.