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The Future of Renal Replacement Therapy in End Stage Kidney Disease Patients (pp. 1-20) $100.00
Authors:  (Bernard Canaud, Ellen Busink, Katrin Koehler, Sudhir Bowry, and Christian Apel)
Renal replacement therapy in end stage kidney disease patients is facing tremendous
challenges that may compromise the actual renal care offering system. How can new
technologies help to address challenges of end stage kidney disease management? The first
aspect is the better use and management of existing vascular accesses and availability of
new bioengineered vascular access technology. The second aspect relies on the
improvement of hemodialyzer technology and membrane manufacturing process that by
combining different properties (diffusive, convective and adsorptive) will increase solute
removal capacity. The third aspect relies on dialysis technology, by incorporating more
specific biosensors, digital and connected technology, the dialysis machine will be able to
provide more efficient and friendly dialysis treatment options, including biofeedback
control systems. The fourth aspect relies on weekly treatment time, since it is a critical
component for improving patient outcomes being linked to solute removal efficacy and
unphysiologic profile of intermittent treatment. More flexible treatment schedules (more
frequent and/or longer sessions) might be considered to fit with specific patient needs. The
fifth aspect involves the use of microsensoring, information communication technology
and analytics. By means of these online tools, dialysis delivery and performances will be
more accurately monitored, while during the interdialytic phase vital functions of high-risk
patients could be remotely controlled. The sixth aspect relies on care management and
quality control of dialysis patients. Accumulating evidence has shown that by keeping
patient in targets for major clinical performance indicators, dialysis patients will live longer
with less hospitalization. The seventh element relates to the health care economic model.
It is becoming clear that the traditional model of “fee-for-service” in dialysis will be over
soon and replaced by a more efficient one, namely “pay-for-performance” and sooner or
later completed by a “value-based” approach. Renal replacement therapy is clearly at a
crossroad. Future of end stage kidney disease management should be addressed in a holistic
and humanistic perspective, according to local practices and resources. New technologies
and innovative concepts will help to partially solve these issues, but care givers, health care
decision makers, medtech and pharma industry should be prepared to face these new

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The Future of Renal Replacement Therapy in End Stage Kidney Disease Patients (pp. 1-20)