TO THE QUESTION ABOUT THE PROSPECTIVE FOR THE UPDATES OF CLINICAL GUIDELINES FOR HEMODIALYSIS

Abstract

In recent years, many new data have been obtained regarding the tactics and strategy of dialysis therapy, which require a revision of existing clinical guidelines. This review of modern criteria for the adequacy of hemodialysis is built in accordance with the Working groups of the 2018 KDIGO Controversies Conference, which is the basis for the development of the update of future clinical guidelines of the International Society of Nephrology. It should be recognized that the intensification of a certain dialysis session has reached a limit in terms of improving meaningful outcomes. At the same time, the individual choice of dialysis modality, conditions for starting and preparing for it, optimization of the ultrafiltration rate, selection of the composition of dialysis solution, and the use of instrumental methods in correcting the water balance allow expanding the possibilities of treatment. The results of the treatment should be evaluated from a patient-oriented position. The concept of “target efficacy” for elderly and frailty patients should gradually give way to the concept of “target tolerance”, in which adequate dialysis should have minimal side effects. At the same time, more frequent, highly effective dialysis may be beneficial in a group of young patients with high metabolic needs. It is worth paying attention to the discord between assessing the significance of outcomes for patients and doctors: a mutual understanding of goals and desires will lead to an increase in compliance with treatment and satisfaction with its results. The purpose of any treatment (including dialysis) should, first of all, not be in conflict with the imperative "noli nocere!".