Did 20 Years of Technological Innovations in Hemodialysis Contribute to Better Patient Outcomes?

Abstract

During the past two decades, impressive technological innovations have been introduced in the field of hemodialysis. This review analyzes whether these have been translated into better patient survival. The potential impacts of an increase in dialysis dosage, the preference of high-flux versus low-flux membranes, the choice between convection and diffusion as dialysis strategy, the chemical composition and biologic purity of dialysate, the effect of sodium, potassium, volume profiling, and the intradialytic volume monitoring aiming at improving hemodynamic stability are explored. Studies in which the dialysis dosage was increased were not associated with increased patient survival, whereas the superiority of high-flux over low-flux membranes is not convincingly demonstrated. Although strict evidence is lacking, observational data suggest an advantage of convective over pure diffusive strategies. Longer duration of the dialysis sessions and/or higher frequency of dialysis is probably beneficial, but the results of powerful randomized, controlled trials should be awaited. Sodium profiling has more disadvantages than advantages, whereas potassium profiling mainly in arrhythmia-prone patients with ventricular hypertrophy should be considered. Intradialytic blood volume monitoring has reduced intradialytic hypotension episodes, but hard evidence for improving patient survival is lacking. Overall, the major technological advances in dialysis have not yet been translated into longer patient survival. Optimal predialysis care in preventing the cardiovascular damage that accumulates before the start of dialysis and timely creation of an arteriovenous fistula as vascular access is a more effective and more economic strategy in the long-term outcome of the dialysis patient.

Education Level Is Associated with Mortality in Male Patients Undergoing Maintenance Hemodialysis

“…Many of the health behaviors that are correlated with mortality are also associated with socioeconomic differences [11]. The role of the medical staff in providing HD includes dialysis dosing, choosing an adequate dialysis membrane (high vs. low flux), purifying the water used in dialysis, and adjusting to hemofiltration (HF) or hemodiafiltration [12]. For patients, however, understanding the treatment facility is more important in this condition compared to others.…”

Advances in Hemodialysis Techniques

“…Recent innovations in the HD techniques have resulted in advancements in specifications of HD machines, HD medical devices, sterile ultrapure solutions and high quality water treatment plants [122]. These advancements have largely contributed to the ability to reconsider the implementation of the other physiologic principle of "convection" [123,124].…”

Introductory Chapter

“…In recent years, HD treatment witnessed significant improvements in HD machines, including designs, weight, mobility, multifunctional touch screens, performance of different modalities of dialysis, assessment of dialysis adequacy and ultrafiltration control [16]. The option of controlled ultrafiltration, for example, has been shown to safely remove excess fluids without exposing dialysis patients to frequent episodes of hypotension [14,17].…”