The current and future landscape of dialysis

Abstract

The development of dialysis by early pioneers such as Willem Kolff and Belding Scribner set in motion several dramatic changes in the epidemiology, economics and ethical frameworks for the treatment of kidney failure. However, despite a rapid expansion in the provision of dialysis — particularly haemodialysis and most notably in high-income countries (HICs) — the rate of true patient-centred innovation has slowed. Current trends are particularly concerning from a global perspective: current costs are not sustainable, even for HICs, and globally, most people who develop kidney failure forego treatment, resulting in millions of deaths every year. Thus, there is an urgent need to develop new approaches and dialysis modalities that are cost-effective, accessible and offer improved patient outcomes. Nephrology researchers are increasingly engaging with patients to determine their priorities for meaningful outcomes that should be used to measure progress. The overarching message from this engagement is that while patients value longevity, reducing symptom burden and achieving maximal functional and social rehabilitation are prioritized more highly. In response, patients, payors, regulators and health-care systems are increasingly demanding improved value, which can only come about through true patient-centred innovation that supports high-quality, high-value care. Substantial efforts are now underway to support requisite transformative changes. These efforts need to be catalysed, promoted and fostered through international collaboration and harmonization.

Prevalence and Associated Factors of Frailty and Mortality in Patients with End-Stage Renal Disease Undergoing Hemodialysis: A Systematic Review and Meta-Analysis

“…End-stage renal disease (ESRD) represents a serious public health problem fueled by aging populations and a pandemic of chronic noncommunicable diseases [ 3 , 4 ]. Although overall mortality rate of the ESRD population is improving, the mortality rate has been reported to be up to 30% within the first year of transition from CKD to ESRD [ 5 , 6 ]. In particular, rapid progression of CKD is associated with worse clinical outcomes, such as cardiovascular events and death [ 6 ].…”

“…Although overall mortality rate of the ESRD population is improving, the mortality rate has been reported to be up to 30% within the first year of transition from CKD to ESRD [ 5 , 6 ]. In particular, rapid progression of CKD is associated with worse clinical outcomes, such as cardiovascular events and death [ 6 ].…”

Exploring factors associated with pain in hemodialysis patients: a multicenter cross‐sectional study from Palestine

“…HD is the most commonly used type of RRT, with over 90.0 % of patients receiving it [ 7 ]. It is also highly effective, halting most of the clinical complications and extending life expectancy [ 8 ].…”

From sleep medicine to medicine during sleep: a new paradigm

“…Dialysis treatments pose a clear burden on patients, which has promoted the development of home-treatment modalities. Both home hemodialysis and peritoneal dialysis were introduced over 50 years ago, but current worldwide trends have shifted towards hemodialysis in a medical center setting in the vast majority of patients 60 . However, interest in home therapies, particularly home hemodialysis, is rising, partly due to its potential nocturnal implementation 61 .…”