Options in Renal Replacement Therapy

Since the introduction over forty years ago of regular dialysis therapy for the management of end stage renal failure there have been dramatic changes in the way this treatment is provided. In pioneering days only a few highly selected patients were considered for treatment and only one treatment option was available (9). Generally, patients were treated twice weekly by haemodialysis for 14 hours with equipment which was, by present day standards, rather inefficient with little or no monitoring. Research and development has resulted in significant advances in dialyser design, membrane performance, and monitoring devices with the consequence that patients are now treated with expensive sophisticated equipment utilising computer assisted controls. Unlike the previous ‘fixed’ regimen patients now have the possibility of treatment ’tailored’ to their individual requirement by using measurements of dialysis adequacy to determine the length of each dialysis session and currently patients’ haemodialysis sessions vary from 2.5 to 6 hours twice or, more commonly, thrice weekly