Sandip Mitra and Kunaal Kharbanda

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/64095

#### **Abstract**

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There has been a resurgence in home haemodialysis over the last decade and interest in online haemodiafiltration in gaining momentum with advances in technology and the results of recent clinical trials. Both increasing haemodialysis frequency and treatment time have a number of potential benefits in improving dialysis efficiency and are ideally placed in the home setting. This chapter describes the rationale behind dialysis treatments, which go beyond conventional haemodialysis (CHD) and future avenues for home dialysis, which may involve combining convective therapy with more frequent treatment.

**Keywords:** haemodialysis, haemodiafiltration, extended haemodialysis, home haemo‐ dialysis

#### **1. Introduction**

Haemodialysis treatment has changed the lives of millions of patients around the world who have advanced kidney disease. The treatment has advanced considerably since the first treatment on a human, lasting just 15 minutes and performed by George Haas in Giessen, Germany, in October 1924 [1]. It was not until the 1960s when maintenance haemodialysis really started and at present, over 90 years since Haas, there are over 400,000 prevalent users in the USA alone [2]. Dialysis provides a bridge to transplantation for some, and for others, it allows survival when residual kidney function is no longer sufficient to sustain life. While the survival of patients has improved since the early days of its inception, the survival of haemodialysis patients remains unacceptably poor. In the United Kingdom, 18% of those aged 65–74 starting haemodialysis will not survive 1 year [3]. Five‐year survival data has often been compared to those of patients with cancer to make the figures more tangible. With recent

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figures showing 50% survival at 5.8 years in the 55–64 years group [4], it is not hard to see why this comparison is made. Clearly, one of the key challenges for the nephrology community is to change this unacceptably high mortality rate. In addition to this, there are many other factors that make a large difference to the patient in front of us, and arguably, these are as impor‐ tant to address and considerably improve.
