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Updates on hemodialysis techniques with a common denominator: The personalization of the dialytic therapy
Author(s) -
Monardo Paolo,
Lacquaniti Antonio,
Campo Susanna,
Bucca Maurizio,
Casuscelli di Tocco Teresa,
Rovito Stefania,
Ragusa Antonino,
Santoro Antonio
Publication year - 2021
Publication title -
seminars in dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 78
eISSN - 1525-139X
pISSN - 0894-0959
DOI - 10.1111/sdi.12956
Subject(s) - medicine , hemodialysis , intensive care medicine , dialysis , uremia , medical prescription , surgery , pharmacology
Hemodialysis (HD) is a life‐saving therapy for patients with end‐stage renal disease. In dialyzed patients, the prevalence of multi‐morbidity is rising driven by various factors, such as the population aging, the incomplete correction of uremia, and the side effects of the dialysis therapy itself. Each dialyzed patient has their own specific clinical and biochemical problems. It is therefore unthinkable that the same dialysis procedure can be able to meet the needs of every patient on chronic dialysis. We have very sophisticated dialysis machines and different dialysis techniques and procedures beyond conventional HD, such as hemodiafiltration (HDF) with pre‐ and post‐dilution, acetate‐free biofiltration (AFB), hemofiltration (HF), and expanded HD. Each of these techniques has its own specific characteristics. To solve some intradialytic clinical issues, such as arterial hypotension and arrhythmias, we have biofeedback systems with automatic regulation of the blood volume, body temperature, arterial pressure, as well as potassium profiling techniques in the dialysis bath. New technical innovations, such as citrate‐containing dialysate or heparin‐coated membranes, could reduce the risk of bleeding. To better address to patient needs, the strengths and weaknesses of each of these systems must be well‐known, in order to have a personalized dialysis prescription for each patient.