Renal replacement therapies – Past, present and future

Abstract

Extracorporeal renal replacement therapy is one of the most successful stories of artificial organ replacement. The current article describes the important steps in the evolution of renal replacement therapy towards modern state of the art peritoneal dialysis and hemodialysis. Open questions and possibilities for future developments are discussed. Today patients have a choice with respect to the method used to replace their failing kidney. However, in order to carefully plan and select the best possible method for a patient, he has to be seen and confronted with the various methods by a nephrologist at least six month before the necessity to start renal replacement therapy. Late referral increases mortality and the necessity for a temporary central venous access represents an additional thrombotic and infectious risk. A patient first seen by the nephrologist at the occasion of an emergeny dialysis will never have the possibility to profit from a preemptive living kidney donation. Furthermore, such patients usually stay in the center and are difficult to motivate for home or selfcare dialysis.