Hemodialysis / 대한내과학회지

ABSTRACT

With the widespread availability of dialysis, the lives of end-stage renal disease patients have been prolonged over the past fifty years. Hemodialysis relies on the diffusion of molecules across a semipermeable membrane along the concentration gradient. In addition to diffusion, movement of waste products from the circulation into the dialysate can occur as a result of convective clearance. Use of high-flux dialyzer has increased the removal of the middle molecules such as beta2-microglobulin. Recently on-line hemodiafiltration which combined the hemodialysis and hemofiltration to increase the convective clearance of the large molecules has been available. About the hemodialysis adequacy, the result of hemodialysis (HEMO) study suggests that increasing the dose to greater than a single-pool Kt/Vurea 1.4 does not improve the survival of the patients. While the technical and scientific improvement in hemodialysis has led to a noticeable improvement in the survival of the dialysis patients, cardiovascular mortality and event rates are extraordinarily high in dialysis population. In addition to hemodialysis treatment, nephrologists taking care of dialysis patients must recognize and treat the diverse complications that can result from the loss of kidney function.