We are well-versed in describing to our soon-to-be ESRD patients their options: kidney transplant, hemodialysis, or peritoneal dialysis. However, in many developing countries, these options do not exist, or there may be a significant delay in getting them set up. A different type of renal replacement therapy is intestinal dialysis.
In intestinal dialysis, the diet is supplemented with soluble fibers such as acacia gum, which is digested by colonic flora, thereby increasing the amount of nitrogen that is eliminated as fecal waste. Apparently when acacia fibers are added to a low protein diet in children with advanced CKD who do not have access to dialysis, their serum BUN levels were slightly lower and they experienced a decrease in uremic symptoms. Admittedly, this would appear to be a much less viable option than PD or HD, but in situations of limited resources it may be valuable.