Patient Selection and Integration of Renal Replacement Therapy

The selection policy used for patients presenting for treatment in a renal replacement program is based on multiple factors which include medical and social aspects and the availability of facilities. Where facilities are not a restricting factor, only a small percentage of patients referred for treatment need be refused (1). Few countries, however, have demonstrated a capacity or willingness to put unrestricted resources at the disposal of nephrologists. Thus, from the outset attention has been paid to the efficient utilisation of available facilities. In Australia on cost grounds, an early decision was taken to promote transplantation actively. It soon became apparent that for optimal therapy to be offered to all patients a combination or ‘integration’ of dialysis and transplantation was necessary (2) and that this could be based on an attempt to find a successful transplant for all medically suitable candidates (1). This approach, now practiced widely in many countries is believed to make maximum use of resources while providing patients with the best possible quality of life.