Future developments in the treatment of end-stage renal disease: a North American perspective

New technology for the treatment of end-stage renal disease will need to be pharmacoeconomically persuasive in reducing the life-cost of treatment to obtain entry into the market. Increased automation, with closed-loop sensing technology, will occur in the near term. Clearance-based terminology for quantifying performance of equipment will give way to direct quantification of toxin removal. Experiments on the frequency and duration of treatment will redefine what is considered to be adequate therapy in terms other than simple urea removal. Near-term changes in current vascular access technology will be driven by the current cost of access failure. Automated peritoneal dialysis will displace continuous ambulatory peritoneal dialysis, and online compounding of solution for use is likely for both hemodialysis and peritoneal dialysis. In a longer time frame these technologies will merge. Xenografting from the pig will be a reality, and gene therapy of the mesothelium will provide a more user-friendly therapy for end-stage renal disease.