Changes in the clinical condition of haemodialysis patients

The characteristics of the dialytic population have substantially changed o ver the past 30 years, becoming older and with a greater number of coexisti ng diseases. The considerable evolution in treatment modalities has lead to a significant increase in the efficacy and tolerability of dialysis. Howev er, physicians have to deal with illnesses in long term dialysis survivors that may be a consequence of inadequate renal replacement therapy rather th an of the dialysis procedure per se. Cardiovascular diseases are the leadin g cause of death and, although many of the risk factors are the same as in the general population (i.e. hypertension), some appear to be specific to C RF (i.e. hyperparathyroidism, anaemia). Age is the most important demograph ic factor associated with increased mortality. The increasing incidence of ESRD diabetic patients, as well as malnutrition, also contribute to higher mortality in RRT. The therapeutic answer to a worsening in clinical conditi on is adequate medical care (starting in the conservative phase), with part icular attention being given to correcting anaemia, hypertension, volume ov erload and hyperparathyroidism, and preventing malnutrition. Treatment moda lities also play a crucial role. Data suggest that adequate dialytic dose l and possibly time) can reduce morbidity and mortality, and on-line sodium a nd potassium modelling can improve intradialytic cardiovascular stability a nd reduce arrhythmias. Long-term treatment with synthetic high-flux membran es may confer some beneficial effect on beta 2-m amyloidosis-related morbid ity and may also reduce mortality. Family and social support greatly affect the quality of life of the patients. However technologically advanced, no procedure can succeed unless it is performed in the context of humanised he alth care directed towards patient needs.