Perspectives in renal replacement therapy: Haemodialysis

Area of Science:

• Nephrology
• Renal Replacement Therapy

Background:

• Haemodialysis (HD) is the most common treatment for end-stage renal disease (ESRD), aiming to replace kidney function.
• Conventional in-centre HD faces challenges including hemodynamic risks, loss of residual renal function, infection, high costs, and potential impact on quality of life.

Purpose of the Study:

• To evaluate the role of Haemodialysis (HD) within integrated end-stage renal disease (ESRD) care models.
• To discuss the impact of technological advancements and new HD modalities on patient outcomes and accessibility.

Main Methods:

• Review of existing literature on Haemodialysis (HD) efficacy, risks, and costs.
• Analysis of the concept of integrated ESRD care and the place of HD within it.
• Examination of recent technological innovations in HD, including frequent HD and haemodiafiltration.

Main Results:

• HD remains a cornerstone of ESRD treatment, but integrated care is crucial for optimizing patient management.
• Despite technological advancements, many new HD therapies are expensive and their benefits are debated, with some studies showing conflicting or negative results.
• The widespread utility of advanced HD modalities is limited in many countries due to cost and accessibility issues.

Conclusions:

• Integrating HD into comprehensive ESRD care strategies is vital for improving patient access and outcomes.
• Careful clinical consideration and cost-benefit analysis are necessary for the appropriate implementation of new and existing HD technologies.
• Future planning must balance the potential of innovative HD therapies with economic realities and evidence of efficacy.