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The current and future landscape of dialysis
Jonathan Himmelfarb1,2, Raymond Vanholder3, Rajnish Mehrotra4,5
1Kidney Research Institute, Seattle, WA, USA. Jhimmelfarb@Nephrology.washington.edu.
Nature Reviews. Nephrology
|August 1, 2020
Summary
Dialysis innovation has slowed, with current treatments being unsustainable and inaccessible globally. Patient-centered approaches prioritizing quality of life and functional rehabilitation are urgently needed for kidney failure treatment.
Area of Science:
- Nephrology
- Medical Technology
- Public Health
Background:
- Dialysis development revolutionized kidney failure treatment but innovation has slowed, particularly in high-income countries (HICs).
- Current dialysis costs are unsustainable, leading to millions of deaths annually as most patients globally forego treatment.
- There is a critical need for cost-effective, accessible dialysis modalities with improved patient outcomes.
Purpose of the Study:
- To highlight the urgent need for patient-centered innovation in dialysis.
- To emphasize the shift in patient priorities towards symptom burden reduction and functional rehabilitation over longevity alone.
- To advocate for international collaboration to foster transformative changes in dialysis care.
Main Methods:
- Review of current trends in dialysis provision and innovation.
- Analysis of patient engagement to identify priorities for meaningful outcomes.
- Assessment of global perspectives on dialysis accessibility and cost-effectiveness.
Main Results:
- Despite increased dialysis provision, true patient-centered innovation has stagnated.
- Patients prioritize reduced symptom burden and functional rehabilitation, alongside longevity.
- Global disparities in access to care result in millions of preventable deaths.
Conclusions:
- A paradigm shift towards patient-centered innovation is essential for high-value kidney failure care.
- New, cost-effective dialysis approaches are required to address global inequities.
- International collaboration and harmonization are crucial to accelerate transformative changes in dialysis.
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