How to prescribe hemodialysis or hemodiafiltration in order to ameliorate dialysis-related symptoms and complications

Abstract

The golden target for dialysis therapy should guarantee longer survival and a higher quality of life without dialysis-related complications. In order to achieve this target, dialysis prescriptions have been modified by increasing the efficiency of uremic solute removal and improving biocompatibility of dialysis membranes. Chronic dialysis patients frequently complain about uncomfortable symptoms such as insomnia, itchy skin, and irritability. Some of these symptoms are well known as independent mortality risk factors. Although these symptoms are serious problems for the patients, they have not yet been a parameter for prescribing a dialysis modality. In our recent experience, dialysis patients had preferences or some feelings concerning their dialysis therapy, for example they favored dialysis membranes which were composed of polymethylmethacrylate, ethylene vinyl alcohol copolymer, and polyacrylnitrate (AN69), and also preferred predilution online HDF. The common characteristics of these modalities are the nutritional advantage, fewer uremic symptoms and a higher survival rate. The mechanisms of these favorable effects were supposed to be caused by well-balanced removal of small solute and low-molecular-weight protein, and by being free from the influence of chemical compositions of dialysis membrane material. The patients' preferences were surely proven to have a scientific basis and could be a useful parameter to prescribe a dialysis modality.