Dialysis at a Crossroads
Open Access
- 1 February 2011
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Clinical Journal of the American Society of Nephrology
- Vol. 6 (2), 457-461
- https://doi.org/10.2215/cjn.08450910
Abstract
The ability to offer repetitive hemodialysis for treatment of chronic kidney failure has now reached its half-century anniversary. Although millions of patients have benefited from this life-extending procedure, current results in the United States have now stagnated with only small annual improvements in survival and continued high hospitalization rates. Recognition that this stagnation may be, at least in part, the result of inadequacies of current and prior paths utilized in dialysis treatment has led to the concept that dialysis therapy is at a crossroads and that new paths need to be articulated, explored, and applied. This article proposes some of these new paths and their rationale. Two elements of the new paths are emphasized: avoidance of indwelling catheters for vascular access and meticulous attention to control of extracellular volume and mitigation of left ventricular hypertrophy and fibrosis. It is postulated that progress in these two areas, along with continued attention to other elements embodied in the new and old paths, will unlock the stagnation in outcomes of dialysis therapy of end-stage kidney failure and allow it to realize its full potential of prolonging life and alleviating disability.This publication has 33 references indexed in Scilit:
- A Randomized, Controlled Trial of Early versus Late Initiation of DialysisThe New England Journal of Medicine, 2010
- Dry-WeightClinical Journal of the American Society of Nephrology, 2010
- Hospital Treatment for Fluid Overload in the Medicare Hemodialysis PopulationClinical Journal of the American Society of Nephrology, 2010
- Propensity-Matched Mortality Comparison of Incident Hemodialysis and Peritoneal Dialysis PatientsJournal of the American Society of Nephrology, 2010
- Functional Status of Elderly Adults before and after Initiation of DialysisThe New England Journal of Medicine, 2009
- Erythropoietin Therapy and Left Ventricular Mass Index in CKD and ESRD PatientsClinical Journal of the American Society of Nephrology, 2009
- Current state of bioimpedance technologies in dialysisNephrology Dialysis Transplantation, 2007
- Effect of Frequent Nocturnal Hemodialysis vs Conventional Hemodialysis on Left Ventricular Mass and Quality of LifeJAMA, 2007
- Fluid balance, dry weight, and blood pressure in dialysisHemodialysis International, 2007
- Septicemia, access and cardiovascular disease in dialysis patients: The USRDS Wave 2 StudyKidney International, 2005