title: Dialysis at a crossroads: 50 years later.
abstract: The ability to offer repetitive hemodialysis for treatment of chronic kidney failure has now reached its half-century anniversary. Although millions of patients have benefited from this life-extending procedure, current results in the United States have now stagnated with only small annual improvements in survival and continued high hospitalization rates. Recognition that this stagnation may be, at least in part, the result of inadequacies of current and prior paths utilized in dialysis treatment has led to the concept that dialysis therapy is at a crossroads and that new paths need to be articulated, explored, and applied. This article proposes some of these new paths and their rationale. Two elements of the new paths are emphasized: avoidance of indwelling catheters for vascular access and meticulous attention to control of extracellular volume and mitigation of left ventricular hypertrophy and fibrosis. It is postulated that progress in these two areas, along with continued attention to other elements embodied in the new and old paths, will unlock the stagnation in outcomes of dialysis therapy of end-stage kidney failure and allow it to realize its full potential of prolonging life and alleviating disability.
authors.affiliation: Renal Ventures Management, 100 Highland Park Village, Suite 200, Dallas, TX 75205, USA. tfparker3rd@yahoo.com
authors.forename: Thomas
authors.initials: T
authors.lastname: Parker
authors.forename: Raymond
authors.initials: R
authors.lastname: Hakim
authors.forename: Allen R
authors.initials: AR
authors.lastname: Nissenson
authors.forename: Theodore
authors.initials: T
authors.lastname: Steinman
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Glassock
mesh_terms: D002408:Catheters, Indwelling / Q000009:adverse effects; D045604:Extracellular Fluid / Q000378:metabolism; D005355:Fibrosis; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000209:etiology / Q000517:prevention & control; D007676:Kidney Failure, Chronic / Q000266:history / Q000378:metabolism / Q000401:mortality / Q000628:therapy*; D006435:Renal Dialysis / Q000009:adverse effects / Q000266:history / Q000401:mortality / Q000639:trends; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014882:Water-Electrolyte Balance