Table 1.

Summary of past, present, and future states of hemodialysis prescription

Element of HD Prescription	Past	Present	Future
Setting	Home HD more common than facility-based HD	Facility-based HD more common than home HD	On the basis of patient preference with individualized prescription
Initiation	Mean eGFRa <5 ml/min per 1.73 m2	Mean eGFRb >10 ml/min per 1.73 m2	Mean eGFR <8 ml/min per 1.73 m2
Metric of dialysis adequacy	Symptoms, nerve conduction studies	spKt/Vurea	Symptoms, small and middle-molecular weight solutes
Frequency	One to two treatments per week, progressing to three treatments per week on the basis of RKF and symptoms	Three treatments per week regardless of RKF	One to two treatments per week, progressing to three treatments per week on the basis of RKF and symptoms
Duration	6–8 h per treatment at once-weekly or twice-weekly frequency	3–4 h per treatment at thrice-weekly frequency	Variable, depending on RKF, volume status, and comorbidities
Dialyzer	• Plate dialyzers • Coil dialyzers • Cellulosic membrane	• Hollow-fiber dialyzers • Capillary and biocompatible membrane	Portable, miniaturized apparatus
Dialysate production system	• Recirculated solution • Sorbent systems	• Single-pass solution • Premanufactured solutions	• Sorbent systems • Carbon block to regenerate dialysate • Sorbent-loaded mixed-matrix membranes
Dialysate base solution	• Acetate	• Bicarbonate (cardiovascular benefit compared with acetate)	• Individualized bicarbonate and electrolyte concentration on the basis of real-time blood measurement during HD treatments

HD, hemodialysis; spKt/V_urea, single-pool Kt/V_urea; RKF, residual kidney function.

^aBetween early 1960s and early 1980s.

^bFrom mid-1980s to present.