Hemodialysis Clinical Trials: A Critical Appraisal

Hemodialysis therapy has been one of the major breakthroughs in medicine in the twentieth century, allowing end-stage renal failure (ESRD) patients to remain alive for years or decades and to restore and continue their social and professional life and for some of them to wait for kidney transplantation. There has been since a tremendous effort in both clinical and engineering research to improve the burden of dialysis therapy and make it safer, easier, and more acceptable. In 50 years since Clyde Shields was started on chronic hemodialysis by Scribner et al. [1], a number of significant progresses have emerged such as the control of ultrafiltration, allowing to optimize convection, the way to assess the dialysis dose, the knowledge on uremic toxins, the release of more biocompatible and selectively permeable membranes, and the importance of nutrition for these patients. However despite all these significant improvements, we all face a persisting huge challenge because of the high mortality rate among dialysis patients, and questioning the current practices in the field of hemodialysis must be a continuous process: When to start dialysis therapy? How long and how frequent hemodialysis should be? Is high-volume convection the key? We owe the answers of these questions to our patients and their families and also to the healthcare authorities to provide the most cost-effective therapy.