Dialysis Modalities and Health Outcomes in Chronic Kidney Disease

Chronic kidney disease (CKD) affects millions worldwide and often progresses to end-stage renal failure, at which point renal replacement therapy becomes essential. Dialysis modalities fall broadly into haemodialysis, in which blood is filtered extracorporeally through a membrane, and peritoneal dialysis, which exploits the peritoneum as a natural filter. Advances in modality choice, vascular access techniques and personalised treatment schedules have altered survival, cardiovascular risk and infection rates. Home-based therapies have grown in prominence, offering improved quality of life and preservation of residual renal function. Incremental dialysis protocols aim to tailor the frequency and duration of sessions to residual kidney function, reducing treatment burden. Despite technological progress, outcomes remain unevenly distributed due to facility characteristics, patient adherence, socioeconomic factors and geographic access. A global emphasis on expanding low-cost alternatives and optimising modality selection is crucial to improve longevity, reduce hospitalisation and enhance patient-reported outcomes.

Research from Nature Portfolio

A large retrospective cohort study explored how the level and size of haemodialysis facilities influence patient survival, cardiovascular and infection-related mortality, hospital admissions and access to transplantation. Data from over 74 000 incident dialysis patients revealed that larger units were associated with modest but significant reductions in all-cause mortality, suggesting economies of scale in nursing expertise and multidisciplinary support. Patients treated in major medical centres experienced lower death rates and higher transplantation rates, whereas those in smaller clinics had fewer hospital admissions but slightly higher mortality. These findings underscore the importance of organisational structure and resource allocation in shaping long-term outcomes for patients commencing haemodialysis.

Dialysis Modalities and Health Outcomes in Chronic Kidney Disease publication trend

The graph below shows the total number of articles in dialysis modalities and health outcomes in chronic kidney disease across all publications each year (not limited to Nature Index journals).

Technical terms

Haemodialysis: A dialysis modality in which a patient’s blood is pumped through an external filter (dialyser) to remove waste products and excess fluid.

Peritoneal dialysis: A home-based dialysis technique using the patient’s peritoneal membrane as a semi-permeable barrier for solute and fluid exchange.

Vascular access: The surgical creation of a conduit (fistula, graft or catheter) to enable repetitive extracorporeal blood flow during haemodialysis sessions.

Residual renal function: The remaining native kidney filtration capacity, preservation of which is associated with improved fluid balance, toxin clearance and nutritional status.

Comorbidity: The presence of one or more additional chronic diseases or conditions co-existing with CKD that influence prognosis and treatment complexity.

References

1. Association of Hospitalization and Mortality Among Patients Initiating Dialysis With Hemodialysis Facility Ownership and Acquisitions. JAMA Network Open (2019).
2. Dialysis attendance patterns and health care utilisation of Aboriginal patients attending dialysis services in urban, rural and remote locations. BMC Health Services Research (2022).
3. The Effects of Distance, Time, and Nonspatial Factors on Hemodialysis Access in Qatar. Cureus (2024).
4. The dialysis facility levels and sizes are associated with outcomes of incident hemodialysis patients. Scientific Reports (2021).