Older and diabetic dialysis patients have been rapidly increasing in the world and it makes us to re-consider what is the aim of chronic renal replacement therapy (RRT). The patients have more comorbidities and complications mainly based on atherosclerosis, then the aim of RRT has changed from life-saving to quality of life (QOL). Recent reports clarified that several QOL parameters such as intra-dialytic hypotension, skin itchiness, insomnia, depression were mortality risk factors on chronic dialysis patients.
To achieve high quality dialysis, there are several key words from the Japanese experiences such as ultrapure dialysis fluid, protein permeable dialysis, nutrition, and dialysis prescription to ameliorate dialysis related symptoms. In health kidney function many low molecular weight proteins as cytokines and other bioactive proteins are filtered at glomerulus and metabolized in the proximal tubules. If we pursue the same quality of healthy kidney function on RRT, we have to remove such kind of proteins. When we try to remove them by high-flux membranes or online hemodiafiltration, we must use ultrapure dialysis fluid. The quality of dialysis prescriptions should be evaluated by nutritional status and the parameters of QOL.
