Advanced Functional Materials in Kidney Dialysis: Progress, Challenges, and Clinical Prospects

Hemodialysis is a critical life-sustaining therapy for patients with end-stage renal disease (ESRD). However, its long-term efficacy is fundamentally constrained by the performance of dialysis membranes. Conventional polymeric membranes, primarily optimized for removing small solutes, are inadequate for clearing middle-molecular-weight and protein-bound uremic toxins (PBUTs), which drive chronic inflammation, cardiovascular dysfunction, and dialysis-related amyloidosis. Moreover, the hydrophobic nature and limited hemocompatibility of existing membranes often trigger immune activation, thrombogenesis, and fouling, compromising both treatment safety and patient comfort. This review provides a critical and integrative assessment of hemodialysis membrane technologies, bridging mechanistic transport theory with recent progress in advanced functional materials. Polymeric, inorganic, biomimetic, and mixed-matrix systems are systematically analyzed to elucidate how structure, surface chemistry, and nanostructure govern toxin selectivity, biostability, and blood compatibility. Emerging strategies, such as zwitterionic and heparin-mimetic coatings, nanomaterial-enabled hybrid architectures, and adsorption-diffusion coupling, are evaluated in relation to clinical scalability and regulatory readiness. Particular emphasis is placed on AI-assisted and data-driven membrane design, sustainable fabrication, and translational engineering as converging directions shaping next-generation dialysis materials. These perspectives collectively outline a roadmap toward safer, smarter, and more durable hemodialysis systems, advancing personalized and environmentally responsible renal replacement therapies.