Challenges for chronic dialysis in the new millennium

Although significant technical advances have occurred in the dialysis industry in the last 20 to 30 years, their collective impact on clinical outcomes has been less well-documented than their commercial successes. This article delineates the technical, administrative, and socioeconomic challenges which must be overcome in the next millennium in order to incorporate predicted technological advances into substantive improvements in quality of life, patient satisfaction, and adequacy of renal replacement therapy in the end-stage renal disease population. Technological advances envisioned include new athrombogenic materials for dialyzers and blood lines; membranes with absorptive properties; more efficient dialyzers; biofeedback sensor systems for physiological control of dialysis, on-line screening, and trend analysis; increased utilization of frequent dialysis; new vascular access techniques; increasing use of practice guidelines; global capitation; and attention to patients' views on standards of care, quality of life, and operation of dialysis facilities. Whereas many new technologies will be available, their application will largely depend on both fundamental research and socioeconomic factors.