| Theme |
Issues of Evidence-based Adequate Dialysis Therapy |
| Title |
Adequate hemodialysis techniques in evidence-based medicine |
| Author |
Toshio Shinoda |
Department of Internal Medicine, Division of Nephrology and Dialysis, Social Insurance Chuo General Hospital |
| [ Summary ] |
Adequate hemodialysis procedures were reviewed, in relation to evidence-based medicine. Concerning hemodialysis membranes, there is level II and III evidence that hemodialysis with a high-flux membrane dialyzer reduces the risks associated with both mortality and quality of life (QOL) in chronic hemodialysis patients. High-flux membrane hemodialysis would accordingly be a grade C or D recommendation to provide adequate hemodialysis treatment. In terms of hemodialysis modality, there is only level V evidence showing improvements in QOL with some hemodiafiltration methods. There is no evidence suggesting improvements in patient mortality, although hemodiafiltration exhibits higher efficiency at removing mid-range and / or large molecular uremic toxins than high-flux membrane hemodialysis. Thus, hemodiafiltration would be a grade E recommendation for providing adequate hemodialysis. |