[We should strive for optimal hemodialysis: treatment time is the key factor].
Nephrologists should strive for optimal hemodialysis. Convection, at least as it is conceived today, is far from optimal and the same is true of standard bicarbonate dialysis. A very recent paper by Eloot et al (Kidney Int 2008: 73: 765-70) clearly illustrates the way towards optimal hemodialysis by showing in a simple and intelligent manner the independent effect of the factor time on the adequacy of hemodialysis. Furthermore, it simplifies the conceptual scenario of dialysis adequacy and points to diffusion mechanisms as the key modality to remove uremic retention solutes. Thus, it is clear that we should strive for longer and/or more frequent dialysis sessions. Long nocturnal home hemodialysis every other night appears to be more appealing to patients than 5 to 7 dialysis sessions a week. The Italian Society of Nephrology should promote trials and the National Health Service should provide funds for these promising hemodialysis schedules.
Basile
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Unità Operativa Complessa di Nefrologia e Dialisi, Ente Ecclesiastico Ospedale Generale Regionalr F Miulli, Acquaviva delle Fonti (Bari), Italy. basile.miulli@libero.it
Lomonte
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D006801:Humans; D006435:Renal Dialysis / Q000379:methods* / Q000592:standards*; D013997:Time Factors