Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Treatments Options for Chronic Kidney Disease

Renal transplant

  • A healthy kidney from a living or deceased donor is transplanted into the recipient.
  • Both recipient and donor have a rigorous work-up prior to the transplant to ensure suitability.
  • Requires daily immunosuppressive medications (which have associated adverse effects) to prevent rejection.
  • Rejection can occur at any time.

Peritoneal dialysis

  • The peritoneal membrane is used to remove waste products and excess water from the circulation with the aid of commercially prepared dialysis solutions administered through a surgically implanted peritoneal dialysis catheter.
  • Most often done as a home therapy; can be performed in most environments.
  • Can be done manually numerous times throughout the day; or at night, while sleeping via the assistance of a machine; or in some cases both.
  • Flexible daily therapy facilitates a more normalized diet and lifestyle.

Hemodialysis

  • A hemodialyzer is used to remove waste products and excess water from the circulation with the aid of a hemodialysis machine.
  •  A fistula/graft created surgically is the preferred route of access to the bloodstream.  A central venous catheter may also be used.
  • Provided in a dialysis facility or at home with varying frequency e.g. daily, nocturnal or intermittent modalities.
  • Diet and fluid restrictions continue for most patients on this type of dialysis.

Conservative management/Palliative care

  • A patient or family may decide to forego or to discontinue renal replacement therapy (RRT) with the intention of accepting death as a natural outcome.

Trial of dialysis

  • A trial of dialysis with a finite time frame may be undertaken when a patient is unsure of the benefit that RRT will provide.
  • The patient/family, as well as members of the Nephrology team, should participate in the discussion at the end of the trial period about the next steps in the continuum of care.

Episodic review

  • Review of treatment modality should be undertaken at any time if the burden of treatment outweighs the benefit to the patient. This should be communicated to the patient during the initial phase of decision coaching and education.