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Continuous renal replacement in the developing world: is there any alternative?

Aamir Jalal Al Mosawi

Background: Dialysis and renal-replacement therapy (RRT) through transplantation were originally developed in an effort to prolong life in patients with end-stage renal failure. However, they have since become common management practice in developed countries. In areas in the developing world where RRT has been introduced to some extent (e.g., hemodialysis and transplantation), despite the lack of effective and skilled teams, rehabilitation is commonly unsatisfactory and results are discouraging relative to costs. Patients undergoing RRT in these areas commonly experience a disproportionate amount of discomfort and suffering which cannot be balanced by the added length of life achieved. Aim: To lower urea elevations in patients with chronic renal failure and symptomatic uremia who were reluctant to undergo dialysis, and to achieve improved wellbeing without dialysis by the use of this novel form of RRT consisting of acacia gum supplementation and a low-protein diet. Patients & methods: From June 2001 to October 2005, 43 patients consisting of 29 males (69%) and 14 females (31%), with symptomatic uremia were referred for treatment due to their unwillingness to undergo dialysis. Ages ranged from 18 months to 81 years. All patients considered dialysis in their circumstance to be associated with an unacceptable degree of discomfort and suffering. No patient presented with a life-threatening uremic complication on referral. All patients were educated regarding the risks of uremia in the absence of maintenance dialysis. Only patients who attended the evaluation visits within 2–3 weeks with an acceptable degree of adherence to the therapeutic protocol were enrolled. It was thus possible to follow 11 patients for 2–16 weeks. Results: All 11 patients enrolled experienced amelioration of symptoms of uremia with improved general wellbeing in association with lowering of urea levels and creatinine during the period of therapy. It was possible to provide hemodialysis freedom to two patients. Conclusion: This is the first study reporting the use of acacia gum in adults with symptomatic uremia, and the first reporting hemodialysis freedom in patients with end-stage renal failure.