Deciphering the core elements around haemodialysis therapy

Abstract

The projected future demand for renal replacement therapies for patients with end-stage renal failure requires preparedness at different levels. The deliberations focus predominantly on the disproportionately high financial burden of care for patients on routine dialysis therapy compared with other chronic conditions. However, even today there are concerns regarding the shortage of healthcare workers in the field of nephrology. A substantial increase in trained healthcare professionals is needed for the future delivery and care of patients requiring haemodialysis (HD) that 89% of patients on dialysis receive; a sustainable health workforce is the cornerstone of any healthcare system. The multimorbid nature of chronic kidney disease as well as the complexity-especially the technical aspects-of HD are deterrents for pursuing nephrology as a career. An educational platform that critically examines the essential issues and components of HD therapy was thus considered appropriate to create or renew interest in nephrology. By providing broader and newer perspectives of some of the core principles around which HD evolves, with this set of articles we seek to facilitate a better appreciation of HD. We believe that such a reappraisal of either poorly understood or ill-defined principles, including usage of terminology that is imprecise, will help facilitate a better understanding of the functioning principles of HD.

Keywords: biocompatibility; evidence-based medicine; hemodialysis; membranes; sustainability.

FIGURE 1:

To cope with the projected future demand for kidney replacement therapies (especially HD), new nephrologists need to familiarize themselves with numerous medical, scientific and technological disciplines. In addition to the pathophysiology of CKD, clinical care of kidney failure patients requires consideration of multiple comorbid conditions and systemic biochemical pathways that afflict an increasingly aging patient population. The challenges are exacerbated by the need to understand complex scientific concepts and technological principles around which HD is based. With the worldwide difficulties in recruiting doctors and nurses for the care of dialysis patients, a concerted educational programme that is less daunting and aids better understanding of the complexities is required.