Large surface area dialysis; innovations and patient management.

The analysis of the middle molecule theory has provided a means for reduced time and large surface area dialysis. Increasing the time-surface area product for the dialysis patient has provided a challenge for the dialysis staff. Rapid ultrafiltration necessitates careful and constant monitoring of these patients to prevent complications such as hypotension and cramping. The use of multiple dialyzers to accomplish large surface area dialysis also increases the cost. However, reuse has become a practical and safe way of decreasing the cost without jeopardizing the efficacy of dialysis. Developing a dialysis prescription to meet the particular needs of each patient, based on middle molecule clearance and residual renal function, appears to be an important factor in the future of large surface area dialysis and its adequacy.