Dialyzer and machine technologies: application of recent advances to clinical practice

Although hemodialysis is a mature therapy, a growing population of patients with more complex medical problems and limitations on resources will require technological innovations to improve the safety, reliability and efficiency of the therapy. The past several years have seen design changes to dialyzers that have provided incremental improvements in small solute clearance and more substantial improvements in the clearance of large solutes. New functions have been added to dialysis machines that help ensure reliable delivery of the dialysis prescription and enable full advantage to be taken of improvements in dialyzer clearance of large molecules. In addition, feedback control systems have been developed that may help reduce the untoward side effects which many patients experience during hemodialysis. Whether or not a particular innovation enters routine clinical use will depend on demonstrating that it improves clinical outcomes, its cost, and, in some cases, on a more enlightened approach by regulatory authorities.