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Dialysis (Renal Replacement Therapy)

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Article Last Updated: 27 March 2026

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Definition

General Indications

Dialysis Modalities

Acute Dialysis

Chronic Dialysis

Haemodialysis (HD)

Peritoneal Dialysis (PD)

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A – Acidosis (metabolic)	Severe, refractory metabolic acidosis (often <7.2)
E – Electrolyte (hyperkalaemia)	Severe, refractory hyperkalaemia
I – Intoxication	Key dialysable drug intoxications include aspirin, lithium, methanol, ethylene glycol
O – Oedema	Severe, refractory pulmonary oedema
U – Uraemia	Uraemia causing encephalopathy, pericarditis

Mechanism	Blood is passed through an external filter (the dialyser), and solute is removed via diffusion
Access	1st line and gold standard: AV fistula However, this needs to be created 6 months before the anticipated start of dialysis to allow maturation Alternatives: Tunnelled catheter – typically used if immediate haemodialysis is necessary, as it does NOT need time for maturation AV graft – typically used if there is poor vessel access
Setting	Standard: in-centre (in hospital / satellite unit), or Home (if appropriate)
Frequency and duration	Standard in-centre HD schedule: 3x a week and 3-5 hours per session Home HD is typically more frequent and/or longer per session, but more flexible
Contraindications	Some relative contraindications: Severe haemodynamic instability (CRRTContinuous renal replacement therapy is preferred) Poor vascular access (PD is preferred if appropriate) Severe coagulopathy
Complications	Access-related: Infection (esp. with AV catheters) Thrombosis Stenosis Bleeding (esp. post-cannulation) Haemodynamic complications: Hypotension (common) Muscle cramps (from fluid and electrolyte shifts) Dialysis disequilibrium syndrome (rare) – rapid urea removal → osmotic shift → cerebral oedema

Mechanism	Dialysate is infused into the peritoneal cavity, and uses the peritoneum as a semi-permeable membrane Fluid is removed via osmosis (via glucose in the dialysate) Electrolytes, urea and creatinine are removed via diffusion
Access	A permanent peritoneal catheter is placed via the anterior abdominal wall
Setting	Home-based Patient-led, high independence (after training) With regular outpatient follow-up
Frequency and duration	Depends on the type: Continuous ambulatory PD 4–5 exchanges per day Each dwell lasts ~4–6 hours Performed during the day Patient can continue normal daily activities Automated PD Performed daily Typically overnight (6–10 hours) Uses a machine (cycler) Patient is asleep during dialysis
Contraindications	Loss of peritoneal membrane function Previous major abdominal surgery (s adhesions impair diffusion) Hernias IBDsInflammatory bowel diseases Poor self-care ability
Complications	PD-associated peritonitis – most important Suspect if there is new abdominal pain + fever + cloudy dialysate Most commonly caused by Staphylococcus epidermidis Access-related Infection Catheter blockage Catheter malposition Mechanical Hernia (due to increased intra-abdominal pressure) Dialysate leak Abdominal discomfort (from fluid distension) Metabolic Hyperglycaemia and weight gain (as the dialysate contains glucose) Chronic Membrane failure Encapsulating peritoneal sclerosis (rare but serious)