Technical advances in hemodialysis therapy

Other than pharmaceutical advancements, the improvements in hemodialysis have largely been due to technical changes. This article summarizes the various technical areas that are noteworthy: hemodialysis membranes; dialysate buffer, electrolyte concentration, and temperature; prescription monitoring; reprocessing; volume-ultrafiltration control; information system interface; arteriovenous access monitoring; water treatment; and continuous and nocturnal dialysis. Within each category, subjective and objective conclusions are drawn as to whether the technical advancements have translated to improved clinical outcomes. In addition, an hypothesis is proposed that due to a confluence of ownership of research and development, manufacturing of equipment, and dialysis facilities conflicts may arise which could slow future technical developments.