Kidney Replacement Therapy by Hemodialysis: 21st Century Challenges

Dear Colleagues,

Currently, about 800 million people are affected by chronic kidney disease (CKD) globally. The number of CKD patients is expected to grow, including those patients at the most advanced CKD stage who require some form of kidney renal replacement therapy (KRTRRT ) to sustain life. Hemodialysis is by far the most frequent form of KRTRRT.

Hemodialysis faces two major challenges: first, the provision of access to affordable hemodialysis globally. It has been estimated that in 2010 about 9.7 million patients would have needed KRT while only 2.6 million had access to it. Projections indicate that in 2030 the number of patients in need for KRT will grow to 14.5 million, while only 5.4 million will have access to it. These numbers show that the gap between patients in need of KRT and those who will have access to it will widen from 7.1 million in 2010 to 9.1 in 2030. This shortfall in KRT is one of the widely unknow human catastrophes. Mitigating it will require highly innovative solutions.  

The second challenge is making hemodialysis more physiological and more efficient. Contact of blood with the extracorporeal circuit results in a host of reactions, such as activation of complement, and immunological and inflammatory responses. Further, hemodynamic instability and hypoperfusion of vital organs during hemodialysis create systemic stress. Novel technologies, including highly biocompatible membranes and feedback systems are paths forward to improve the hemodialysis experience for patients and thus their quality of life. As it is highlighted by most studies, RRT delivered in its conventional way as short high-flux hemodialysis (12 hours a week) covers only about 15 to 20% of the excretory native kidney function. Such limited efficiency may explain in large part the so-called remaining kidney burden and the poor long-term outcomes of conventional RRT. Therefore, in an attempt of enhancing treatment efficiency in the future, new or combined approaches are clearly needed to enhance solute removal capacities in particular for middle-, large-, and protein bound uremic toxins.

Prof. Dr. Peter Kotanko
Prof. Dr. Bernard Canaud
Dr. K S Nayak
Guest Editors

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• hemodialysis
• biocompatibility
• dialyzer
• extracorporeal circuit
• ultrafiltration control
• novel hemodialysis technologies
• epidemiology