Dialysis treatment: an unfulfilled promise

• Published in: Nederlands tijdschrift voor geneeskunde Vol. 154; p. A1988
• Main Author: Mees, Evert J Dorhout
• Format: Journal Article
• Language: Dutch
• Published: Netherlands 2010
• Subjects: Blood Volume - physiology; Body Fluids - metabolism; Body Fluids - physiology; Humans; Renal Dialysis - adverse effects; Renal Insufficiency - mortality; Renal Insufficiency - therapy; Risk Factors; Time Factors; Treatment Outcome; Urea - metabolism
• ISSN: 0028-2162; 1876-8784

In the last 50 years, the morbidity and mortality of patients on maintenance dialysis treatment has remained unacceptably high. This is because insufficient attention is paid to the main task of the kidneys: body fluid volume regulation. While nobody denies these basic physiologic principles, several developments have contributed to their neglect. First, a tendency towards short dialysis sessions and even more unfortunately the emphasis of opinion leaders on removal of urea, the least toxic of the metabolites. The necessity of severe dietary salt restriction is insufficiently stressed. Thus most patients remain slightly volume expanded, causing not only hypertension, but also dilatation of the heart. This leads to cardiovascular damage and even pulmonary oedema ('heart failure'), an entirely preventable complication. While several authors have shown better results by applying these principles, the focus on randomised controlled trials, which are practically unfeasible in this setting, still precludes their general acceptance.