[Hemo- and peritoneal dialysis: what non-nephrologists should know].

Hemo- and peritoneal dialysis: what non-nephrologists should know Abstract. Haemodialysis and peritoneal dialysis are widely available procedures, which prolong life for increasingly old and polymorbid patients with end-stage renal disease. In selected patients dialysis serves a bridging purpose until renal transplantation, in older and frail patients dialysis is performed until the end of life. Both dialysis modalities are cumbersome, wearying and costly treatments. They substitute renal function suboptimally and are associated with reduced quality of life. The choice of renal replacement therapy should be patient-centred and include extensive information by a multidisciplinary team. The preferences of the patient should dictate the choice of the dialysis method unless medical contraindications limit the treatment options. Haemodialysis is a very potent form of renal replacement therapy and it is perfomed intermittently, usually three times weekly in a dialysis facility. Peritoneal dialysis is a more gentle procedure and it is performed by the patient continuously at home, either independently or with support from carers. Patient survival with both dialysis methods is comparable. Technical problems occur less frequently with haemodialysis whereas quality of life is rated higher by peritoneal dialysis patients. Dialysis should not be started too early. Unless the glomerular filtration rate is very low (eGFR < 6 ml / min / 1.73 m2) the initiation of dialysis can be delayed as long as hypervolaemia is controlled, uraemic symtoms are not present and blood results are not menacing. Patients on dialysis are chronically ill, often highly polymorbid and psychosocially burdened. A multidisplinary team is necessary to meet their complex needs. The primary care physician plays an important role in the care of these patients. Recognition of risk factors or early stages of kidney disease combined with early referral to a nephrologist are important for the treatment of curable diseases, for the prevention of secondary complications of renal failure and for the optimal selection and preparation of renal replacement therapy.