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Review
. 2020 Mar 1;35(Suppl 2):ii51-ii57.
doi: 10.1093/ndt/gfaa005.

The renal replacement therapy landscape in 2030: reducing the global cardiovascular burden in dialysis patients

Bernard Canaud  1   2 , Allan Collins  1 , Frank Maddux  1
Affiliations
Review

The renal replacement therapy landscape in 2030: reducing the global cardiovascular burden in dialysis patients

Bernard Canaud et al. Nephrol Dial Transplant. .

Abstract

Despite the significant progress made in understanding chronic kidney disease and uraemic pathophysiology, use of advanced technology and implementation of new strategies in renal replacement therapy, the clinical outcomes of chronic kidney disease 5 dialysis patients remain suboptimal. Considering residual suboptimal medical needs of short intermittent dialysis, it is our medical duty to revisit standards of dialysis practice and propose new therapeutic options for improving the overall effectiveness of dialysis sessions and reduce the burden of stress induced by the therapy. Several themes arise to address the modifiable components of the therapy that are aimed at mitigating some of the cardiovascular risks in patients with end-stage kidney disease. Among them, five are of utmost importance and include: (i) enhancement of treatment efficiency and continuous monitoring of dialysis performances; (ii) prevention of dialysis-induced stress; (iii) precise handling of sodium and fluid balance; (iv) moving towards heparin-free dialysis; and (v) customizing electrolyte prescriptions. In summary, haemodialysis treatment in 2030 will be substantially more personalized to the patient, with a clear focus on cardioprotection, volume management, arrhythmia surveillance, avoidance of anticoagulation and the development of more dynamic systems to align the fluid and electrolyte needs of the patient on the day of the treatment to their particular circumstances.

Keywords: Stage 5 chronic kidney disease dialysis; advancing outcome; dialysis; renal replacement therapy; technology support.

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Figures

FIGURE 1
FIGURE 1
Renal replacement therapy integrated and patient centred approach concept.
FIGURE 2
FIGURE 2
Advances in blood purification by extracorporeal therapy with a patient-centric approach. TBW, total body weight; LTM, lean tissue mass; FTM, fat tissue mass; HD, haemodialysis; OCM, online clearance measurement.
See this image and copyright information in PMC

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