Global Medical Office, Fresenius Medical Care, Bad Homburg, Germany.
School of Medicine, Montpellier University, Montpellier, France.
Nephrol Dial Transplant. 2020 Mar 1;35(Suppl 2):ii51-ii57. doi: 10.1093/ndt/gfaa005.
Despite the significant progress made in understanding chronic kidney disease and uraemic pathophysiology, use of advanced technology and implementation of new strategies in renal replacement therapy, the clinical outcomes of chronic kidney disease 5 dialysis patients remain suboptimal. Considering residual suboptimal medical needs of short intermittent dialysis, it is our medical duty to revisit standards of dialysis practice and propose new therapeutic options for improving the overall effectiveness of dialysis sessions and reduce the burden of stress induced by the therapy. Several themes arise to address the modifiable components of the therapy that are aimed at mitigating some of the cardiovascular risks in patients with end-stage kidney disease. Among them, five are of utmost importance and include: (i) enhancement of treatment efficiency and continuous monitoring of dialysis performances; (ii) prevention of dialysis-induced stress; (iii) precise handling of sodium and fluid balance; (iv) moving towards heparin-free dialysis; and (v) customizing electrolyte prescriptions. In summary, haemodialysis treatment in 2030 will be substantially more personalized to the patient, with a clear focus on cardioprotection, volume management, arrhythmia surveillance, avoidance of anticoagulation and the development of more dynamic systems to align the fluid and electrolyte needs of the patient on the day of the treatment to their particular circumstances.
尽管在理解慢性肾脏病和尿毒症病理生理学方面取得了重大进展，在肾脏替代治疗中使用了先进技术和实施了新策略，但慢性肾脏病 5 期透析患者的临床结局仍然不理想。考虑到间歇性透析仍存在一些未满足的医疗需求，我们有医学责任重新审视透析实践标准，并提出新的治疗选择，以提高透析治疗的整体效果，并减轻治疗带来的压力负担。有几个主题出现，旨在解决治疗中可改变的部分，旨在减轻终末期肾病患者的一些心血管风险。其中，有五个是最重要的，包括：（i）提高治疗效率和持续监测透析效果；（ii）预防透析引起的压力；（iii）精确处理钠和液体平衡；（iv）向无肝素透析过渡；以及（v）定制电解质处方。总之，2030 年的血液透析治疗将更加针对患者个体化，重点关注心脏保护、容量管理、心律失常监测、避免抗凝以及开发更具动态性的系统，以根据患者的特殊情况在治疗当天调整其液体和电解质需求。
