A highly diverse
team imagining
the undiscovered

Bernard Canaud, Jeroen P Kooman, Nicholas M Selby, Maarten Taal, Andreas Maierhofer, Pascal Kopperschmidt, Susan Francis, Allan Collins, Peter Kotanko

The development of maintenance hemodialysis (HD) for end stage kidney disease patients is a success story that continues to save many lives. Nevertheless, intermittent renal replacement therapy is also a source of recurrent stress for patients. Conventional thrice weekly short HD is an imperfect treatment that only partially corrects uremic abnormalities, increases cardiovascular risk, and exacerbates disease burden. Altering cycles of fluid loading associated with cardiac stretching (interdialytic phase) and then fluid unloading (intradialytic phase) likely contribute to cardiac and vascular damage. This unphysiologic treatment profile combined with cyclic disturbances including osmotic and electrolytic shifts may contribute to morbidity in dialysis patients and augment the health burden of treatment. As such, HD patients are exposed to multiple stressors including cardiocirculatory, inflammatory, biologic, hypoxemic, and nutritional. This cascade of events can be termed the dialysis stress storm and sickness syndrome. Mitigating cardiovascular risk and morbidity associated with conventional intermittent HD appears to be a priority for improving patient experience and reducing disease burden. In this in-depth review, we summarize the hidden effects of intermittent HD therapy, and call for action to improve delivered HD and develop treatment schedules that are better tolerated and associated with fewer adverse effects.

Renal Research Institute’s 23rd International Conference on Dialysis - Advances in Kidney Disease is rescheduled for April 20-23, 2021, but acknowledges the renal community has immediate access to the latest COVID-19 kidney care science and knowledge via online platforms. New York, March 18, 2021 – While the Renal Research Institute (RRI) has rescheduled its 23rd...