Progress in hemodialysis.

Bioengineering research over the past 16 years has provided clear definition of the design parameters controlling solute transport in dialyzers and resulted in the present dialysis systems which have a broad range of solute transport and ultrafiltration properties with predictable performance. Research into the pathophysiology of uremia has further established the role of protein catabolism in pathogenesis and resulted in information indicating that endocrine metabolic, drug toxicity and immunologic pathogenetic mechanisms may also be operative in this complex syndrome. Average dialysis treatment time has decreased more than 50 percent over the last ten years, but to a considerable extent remains empirically determined. Progress in elucidation of the solute kinetic parameters controlling solute concentration during regular dialysis therapy (RDT) is reviewed and the critical role of mass balance in evaluation of this therapy is discussed. Progress in kinetic modeling to quantify RDT is reviewed, the limitations of current kinetic models are considered and anticipated requirements to develop improved model parameters outlined.