Preparation for renal replacement therapy

Although the primary aim of management in chronic kidney disease (CKD) is to prevent progression to stage 5 CKD, for many patients renal replacement therapy (RRT) is inevitable. Planning for the initiation of dialysis is aimed at ensuring that it takes place in a supported environment in which adverse events will be minimized, that the modality chosen is appropriate for the individual circumstances, and the patient has full knowledge of what RRT entails. Beginning dialysis inevitably involves medical, psychological, family, and social issues, and preparation for RRT is optimally managed by a team with appropriate expertise in these areas. Multidisciplinary education programmes that inform patients and their families about their disease and the treatment options are likely to result in patients starting dialysis in a planned and elective manner.