Haemodialysis

The haemodialysis population continues to increase rapidly 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. More frequent treatments may be necessary to adequately control uraemia and to improve survival. Haemodiafiltration provides improved β2-microglobulin clearance over haemodialysis, and may improve outcomes. Failures in access provision, particularly over-dependence on tunnelled lines, contribute significantly to morbidity and excess mortality.