Preparing for the future

Dialysis populations around the world are rising.1,2 Although recent growth is almost completely attributable to improving survival, mortality rates remain much higher than in age-matched U.S. residents, and conventional, thrice-weekly hemodialysis may not adequately address:

  • High risk of cardiovascular morbidity and mortality3,4
  • High pill burden5
  • Diminished quality of life6,7
  • Limited tolerability of conventional hemodialysis treatment8,9

To improve the quality of patients’ lives, intensive dialysis should be considered to address the fundamental complications that limit the long-term efficacy of conventional hemodialysis.

Impediments to increasing intensity include physicians and dialysis providers, who each must fairly present to patients and their families the alternatives that exist to normalize life with dialysis, and payers, who must recognize that potentially increased dialysis costs can be offset by decreased costs due to acute care and medications for comorbid complications.

Reviews—summarized on this website and available in full for download—present clinical evidence for intensive hemodialysis and innovative perspectives on the role that intensive therapy may play in improving patient outcomes.


  1. Liyanage T, Ninomiya T, Jha V, et al. Worldwide access to treatment for end-stage kidney disease: a systematic review. Lancet Lond Engl. 2015;385(9981):1975-1982. doi:10.1016/S0140-6736(14)61601-9.
  2. Thomas B, Wulf S, Bikbov B, et al. Maintenance Dialysis throughout the World in Years 1990 and 2010. J Am Soc Nephrol JASN. 2015;26(11):2621-2633. doi:10.1681/ASN.2014101017.
  3. Deaths: Final Data for 2012.; 2014. Accessed May 20, 2015.
  4. Saran R, Li Y, Robinson B, et al. US Renal Data System 2014 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis Off J Natl Kidney Found. 2015;66(1 Suppl 1):Svii, S1-305. doi:10.1053/j.ajkd.2015.05.001.
  5. Chiu Y-W, Teitelbaum I, Misra M, de Leon EM, Adzize T, Mehrotra R. Pill burden, adherence, hyperphosphatemia, and quality of life in maintenance dialysis patients. Clin J Am Soc Nephrol CJASN. 2009;4(6):1089-1096. doi:10.2215/CJN.00290109
  6. The DOPPS Practice Monitor. Accessed May 20, 2015.
  7. Ware J, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220-233.
  8. Moist LM, Bragg-Gresham JL, Pisoni RL, et al. Travel time to dialysis as a predictor of health-related quality of life, adherence, and mortality: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis Off J Natl Kidney Found. 2008;51(4):641-650. doi:10.1053/j.ajkd.2007.12.021.
  9. Rayner HC, Zepel L, Fuller DS, et al. Recovery time, quality of life, and mortality in hemodialysis patients: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis Off J Natl Kidney Found. 2014;64(1):86-94. doi:10.1053/j.ajkd.2014.01.014.
  10. Kotanko P, Garg AX, Depner T, et al. Effects of frequent hemodialysis on blood pressure: Results from the randomized frequent hemodialysis network trials. Hemodial Int. 2015;19(3):386-401. doi:10.1111/hdi.12255.
  11. Zoccali C et al. Chronic Fluid Overload and Mortality in ESRD. JASN August 2017, 28 (8) 2491-2497; DOI:
  12. Zoccali C et al. Left ventricular mass monitoring in the follow-up of dialysis patients: Prognostic value of left ventricular hypertrophy progression. Kidney Int. 2004;65(4):1492-1498.
  13. Pun PH, Herzog CA, Middleton JP. Improving ascertainment of sudden cardiac death in patients with end stage renal disease. Clin J Am Soc Nephr. 2012;7(1):116-122.