How can we improve the solute and fluid transport prescriptions in hemodialysis to improve patient outcomes?

Improvements in the dialysis prescription can only be achieved by changes in solute and water transport which provide better control of the metabolic uremic abnormalities that are amenable to dialysis. The key abnormalities identified here are protein catabolites, fluid and electrolyte balance, calcium and phosphorus balance and bone metabolism and acid-base balance. The history of the dialysis prescription is reviewed and changes which might improve the control of these metabolic systems are described. This review concludes there is no support for the recommendation of the routine application of long treatment time and routine use of hemodiafiltration.