Abstract
Dialysis is a complement to or a substitute for renal transplantation. Mortality of dialysis patients remains too high - 9-22%/year - and is associated above all with old age and comorbidities but also with the quantity and quality of hemodialysis. Hemodialysis must be more personalized, with a possible increase in its frequency (daily) or in the duration of sessions (longer than 4.5 h). Chronic inflammation, present in 30% of patients, is a source of morbidity and mortality. It must be detected by ultrasensitive CRP (C-reactive protein) assays and its cause sought and treated. Metabolism of phosphate and calcium is too often inadequately controlled, despite the contribution of new very active molecules. The resultant vascular calcifications are an important cardiovascular risk factor. Progress in dialysis techniques also plays a role in improving quality of life and life span: use of highly permeable membranes, ultrapure dialysate, closed-loop biofeedback volume control, and maintenance of thermal balance.
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