Haemodialysis

The haemodialysis population continues to increase and is becoming more elderly and dependent. Despite major advances in technology, long-term clinical outcomes are disappointing, even in low-risk patients. Current definitions of dialysis adequacy, based on urea clearance, need to be broadened to encompass parameters such as β2-microglobulin clearance, salt and water balance, and phosphate control. Haemodiafiltration provides improved β2-microglobulin clearance over haemodialysis, and may improve survival. There is a trend towards individualizing haemodialysis dose to the needs of the patient. Patients with significant residual kidney function may require less dialysis. For others without residual function, more frequent treatments may be necessary to adequately control uraemia and volume status, and to improve survival. Home-based treatment can facilitate more frequent treatments for a proportion of patients, although centre-based therapy remains the default for the majority.