Renal replacement therapy is a broad term encompassing all therapeutic modalities which can be used to remove the toxins and metabolites of body in case of inadequate functioning of kidneys. It includes following:

1. Haemodialysis
2. Peritoneal dialysis
3. Renal transplant (only for chronic kidney disease)

Haemodialysis means dialysis of blood; in simple terms filtration of blood with the help of machines and tubings. This is the most common type of dialysis performed in our country. It could be of following types:

1. Intermittent haemodialysis
2. Haemodiafiltration
3. SLED (Slow low efficiency dialysis)
4. CRRT (Continuous renal replacement therapies)

Peritoneal dialysis is a treatment for kidney failure that uses the lining of your abdomen, or belly, to filter your blood inside your body. Health care providers call this lining the peritoneum.
A few weeks before you start peritoneal dialysis, a surgeon places a soft tube, called a catheter, in your belly. When you start treatment, dialysis solution—water with salt and other additives—flows from a bag through the catheter into your belly. When the bag is empty, you disconnect it and place a cap on your catheter so you can move around and do your normal activities. While the dialysis solution is inside your belly, it absorbs wastes and extra fluid from your body.

Dialysis is usually required when kidneys are not able to remove toxins and metabolites and which are causing unusual side effects over rest of the body systems.
In Chronic kidney disease dialysis is initiated when patient have one or more of the following features:

• Advanced azotemia (S creatinine > 6 or 7 mg/dl)
• Recurrent nausea or vomiting
• Decreased apetite
• Swelling over body
• Decreased urine output
• Shortness of breath
• Persistently high level of potassium
• High level of acid accumulation in body

Not in every case. In acute kidney injury there is fairly good chance that kidneys might recover and patient may not require long term dialysis. In most of the chronic kidney disease patient dialysis might be required on regular basis.

Usually twice or thrice a week dialysis session of four hours each is required for a patient with chronic kidney disease.

Advantages of peritoneal dialysis over haemodialysis:

• Can be performed at home or work place
• Better quality of life
• Better preservation of residual renal function
• Better haemodynamic stability

Disadvantages of peritoneal dialysis:

• Has to be done at least thrice a day
• Require proper training
• Needs appropriate cleanliness and hygiene to reduce infection
• Slightly more costly

Haemodialysis over the time period has improved drastically and with the advent of better machines and technology complication rates have markedly come down. Following are the common side effects which one can face during haemodialysis:

• Fall in blood pressure
• Fall in blood sugar level
• Alteration in heart beat
• Nausea, vomiting

SLED or CRRT are considered once the patient has low blood pressure or poor cardiac function. Costing of SLED and CRRT is higher as compared to normal dialysis but has lesser chances of haemodynamic instability.

Undoubtedly Renal transplant remains the best form of renal replacement therapy in terms of quantity or quality of life. It is most financially viable solution for chronic kidney disease patient in long run.