Future developments in the treatment of end-stage renal disease: A North American perspective

New technology for the treatment of end-stage renal disease will need to be pharmacoeconomically persuasive in reducing the life-cost of treatment to obtain entry into the market. increased automation, with closed-loop sensin g technology, will occur in the near term. Clearance-based terminology for quantifying performance of equipment will give way to direct quantification of toxin removal. Experiments on the frequency and duration of treatment w ill redefine what is considered to be adequate therapy in terms other than simple urea removal, Near-term changes in current vascular access technolog y will be driven by the current cost of access failure. Automated peritonea l dialysis will displace continuous ambulatory peritoneal dialysis, and onl ine compounding of solution for use is likely for both hemodialysis and per itoneal dialysis, In a longer time frame these technologies will merge. Xen ografting from the pig will be a reality, and gene therapy of the mesotheli um will provide a more user-friendly therapy for end-stage renal disease. ( C) 2000 by the National Kidney Foundation, Inc.