Haemoperfusion in the management of end-stage renal disease

Haemoperfusion, mainly in the form of activated charcoal haemoperfusion, has been investigated for the treatment of end-stage renal disease. Short-term studies have demonstrated that charcoal haemoperfusion devices in combination with haemodialysis are safe, produce reversal of certain symptoms of uraemia, but do little to define the role of haemoperfusion in the management of end-stage renal disease. Long-term studies, however, have demonstrated that reduction in dialysis time may be achievable with the addition of charcoal haemoperfusion to dialysis or ultrafiltration in the routine management of the dialysis patient. However, since charcoal as an adsorbent fails to remove important uraemic toxins such as water, urea, electrolytes, phosphate and sulphate, haemoperfusion does require the addition of dialysis or ultrafiltration for the removal of such toxins. In future, haemoperfusion will probably consist of sorbents added to an ultrafiltration or dialysis device to form a hybrid artificial organ that will combine sorbents suitable for removal of urea, phosphate, etc., and will be a useful treatment in the routine management of end-stage renal disease.