Kidney replacement therapy and global issues: world experience and our challenges

Abstract

The problem of renal replacement therapy (RRT) is relevant in today’s world due to a large number of people with chronic kidney disease (CKD). According to current data, about 10–11 % of people suffer from CKD, of which up to 5 % need RRT. Unfortunately, the number of people with CKD in the world is increasing, which determines the growing need for RRT. There are three types of RRT, namely: hemodialysis, peritoneal dialysis, and kidney transplantation. Kidney transplantation is the most effective method of RRT, but its possibilities in the world are limited. Therefore, most people receive hemo- or peritoneal dialysis. But the long-term effects of choosing a dialysis method are not always predictable. The peritoneal dialysis and hemodialysis show similar effectiveness during the first two years. Subsequent studies compa­ring the efficacy of the two methods do not provide a clear picture due to differences in patient initial parameters and differences in treatment initiation time. It is clear that peritoneal dialysis can have significant advantages in low-income countries due to the resource costs of the latter. The known benefits of peritoneal dialysis, such as flexibility of use, high quality of life, and preservation of residual renal function, increase its attractiveness, especially for young people with stage 5 CKD. The main strategies today are timely detection and prevention of CKD, control of comorbidities, as well as the development of documents and recommendations for standardization and improving the quality of renal replacement therapy.