[Is conventional hemodialysis an appropriate dialysis?]

Conventional hemodialysis, three sessions per week through a low-flux membrane, is the dialysis method most widely used. However, its efficacy is limited. The concept of dialysis adequacy exclusively based on the concept of Kt/V is too restrictive. Other solutes such as middle molecules should also be considered. Parameters such as phosphate and hypertension are very difficult to control with the conventional schedules. Observational studies demonstrate both a high morbidity and mortality. It is necessary a qualitative leap forward from the current concept of "adequate dialysis" to a more modern of "optimal dialysis". Different strategies than those shown in recent prospective studies are needed to achieve that goal.