Haemodialysis

The population undergoing haemodialysis continues to expand, with an increasing prevalence of elderly dependent patients including those aged >80 years. Despite major advances in technology, long-term clinical outcomes are disappointing, even in low-risk patients. Current definitions of adequacy of dialysis, based on urea clearance, need to be broadened to encompass parameters including middle molecule clearance, salt and water balance, and patient symptoms and well-being. Haemodiafiltration provides improved middle molecule clearance over haemodialysis, with some evidence of improved survival.