Is the term ‘renal support therapy’ more appropriate than ‘renal replacement therapy’?

Sir,

The editorial comment ‘The importance of residual renal function for patients on dialysis’ [1] published in the April issue of the journal was indeed thought-provoking. The authors have emphasized (and rightly so) the importance of residual renal function, since it is the most important predictor of mortality in dialysis patients. In addition to the factors discussed by the authors, the other important factors for preservation of residual renal function are prevention of obesity and treatment of dyslipidaemia. This brings into focus the inadequacies of the current dialytic therapies, which really cannot replace the functions of the natural kidney. Although too well known, it may be pertinent to note in this context that the vital endocrine functions of the kidney, which intricately regulate blood pressure, bone physiology and erythropoiesis, are completely beyond the scope of the dialytic therapies. Even the excretory function of the kidney is inadequately supplanted. In addition, the quality of life with these therapies is definitely inferior. Allograft renal transplantation is so unphysiological that it has created a totally new field of transplantation medicine, which is still incompletely understood. Hence the question arises: is the term ‘renal replacement therapy’, currently in vogue for treatment of patients with acute renal failure/end-stage renal disease [2,3], really justified? We strongly feel that a more appropriate term would be ‘renal support therapy’. Perhaps when the bioartificial kidney and stem cell regeneration become clinical realities, we may be able truly to replace the functions of the natural kidney. Till then, ‘renal support therapy’ would convey more effectively the limitations of current technology. This also has significant relevance in patient education. The current term gives the incorrect impression that health care providers have mastered renal failure. Patients need to understand that dialytic therapies cannot substitute the functions of a normal kidney, but are useful as a life support system. (Of course this is no mean achievement in a patient with a major organ failure.) The new term will reinforce the importance of preventing/slowing the progression of chronic kidney disease and also help patients cope with the problems of treatment in a better way. We hope that this matter is actively discussed by the nephrology community.

Conflict of interest statement. None declared.

Suresh C. Tiwari, Dipankar M. Bhowmik and Suresh C. Dash

All India Institute of Medical Sciences, Nephrology New Delhi India Email: dbhowmik{at}aiims.ac.in or dmbhowmik{at}rediffmail.com

References

  1. Bargman JM, Golper TA. The importance of residual renal function for patients on dialysis. Nephrol Dial Transplant 2005; 20: 671–673[Free Full Text]
  2. Dollins M, Kraus MA, Molitoris BA. Intensive care nephrology. In: Brenner BM, ed. Brenner & Rector's The Kidney, 7th edn. Saunders an imprint of Elsevier, Philadelphia; 2004: 2697–2732
  3. Roderick PJ, Feest T. The epidemiology of renal disease. In: Davison AM, Cameron JS, Grunfeld JP et al., eds. Oxford Textbook of Clinical Nephrology, 3rd edn. Oxford University Press, Oxford; 2005: 195–209




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