Treatment Modalities and Clinical Management
Modalities
Hemodialysis uses diffusion and convection across a dialyzer; peritoneal dialysis uses the peritoneal membrane with prescribed dwells; transplantation offers the best long-term outcomes for many eligible patients. Conservative kidney management is a valid choice. Candidates should know access types, dialysis prescription, ultrafiltration, adequacy, residual kidney function, and complications. Hemodialysis access options include arteriovenous fistula, graft, and catheter; catheters carry the highest infection risk. Peritoneal dialysis requires catheter care and monitoring for peritonitis. Transplant care includes immunosuppression, infection prevention, rejection surveillance, and medication interactions.
Clinical management and traps
Manage volume with dry weight, sodium and fluid limits, and individualized ultrafiltration. Avoid rapid fluid removal that causes hypotension or cramps. Monitor potassium, phosphorus, calcium, acid-base status, anemia, and nutrition. Adequacy targets are commonly single-pool Kt/V at least 1.2 for three-times-weekly hemodialysis and weekly Kt/V at least 1.7 for peritoneal dialysis. Traps include confusing diffusion with ultrafiltration, ignoring residual kidney function, and overlooking transplant drug interactions.
Worked example
A hemodialysis patient gains 2.5 kg between treatments. Over a 4-hour session, the ultrafiltration rate is 625 mL/hour. For an 80-kg patient, that is about 7.8 mL/kg/hour, which is generally acceptable; higher rates may increase hypotension risk. Rule of thumb: calculate ultrafiltration rate and compare it with the patient's tolerance, not just the total volume removed.