[Hemodialysis in the treatment of chronic kidney failure. Present status]

Abstract

In advanced countries haemodialysis treatment is available to all patients with chronic renal failure who need it. At present nephrologists must resolve the problem when it is possible to with-hold long-term haemodialysis treatment, or withdraw it because it no longer leads to prolongation of a good quality life. The results of long-term dialysis treatment depend on the correct timing of its initiation and the quality of nephrological care provided already a long time before the development of renal failure. The morbidity, mortality and quality of life of the patients are influenced in a fundamental way by the quality of provided haemodialysis. An important factor is the dose of dialysis treatment evaluated according to index Kt/Vurea reflecting the urea elimination and obviously also the elimination of other low molecular weight substances. Although prospective controlled trials did not prove so far a favourable effect of haemodialysis membranes permeable for larger molecules ("high-flux" membranes) on the patients' fate, the possible toxic effect of so-called middle molecule substances and peptides with a low molecular weight is assumed. Data suggesting improvement of the quality of life of patients having daily haemodialyses call for further investigations. A still unresolved problem of contemporary haemodialysis systems remains inadequate biocompatibility which leads to reactions associated with possible acute and long-term damage of dialyzed patients.