Dialysis Outcomes and Practice Patterns

The global burden of end-stage kidney disease continues to rise, driven by ageing populations and increasing prevalence of diabetes and hypertension. Dialysis remains the predominant form of renal replacement therapy, encompassing in-centre haemodialysis, haemodiafiltration, peritoneal dialysis and home therapies. Outcomes have improved over recent decades through refinements in membrane technology, water treatment, vascular access management and uraemic toxin control. Nevertheless, mortality rates remain high, with cardiovascular complications, infection and malignancy accounting for the majority of deaths. Practice patterns vary widely by region, reflecting differences in resource availability, reimbursement policies and clinical guidelines. The adoption of haemodiafiltration has grown markedly in some countries due to potential benefits in middle molecule clearance, while peritoneal dialysis use remains limited by concerns over technique failure and peritonitis. Home dialysis modalities show promise for patient autonomy and quality of life but remain under-utilised. Emerging emphasis on individualised prescriptions, strict control of mineral and bone disorder, optimisation of anaemia management and shared decision-making aims to align treatment with patient values and reduce global disparities.

Research from Nature Portfolio

Recent studies have provided detailed registry data from rapidly expanding haemodialysis populations. A large prospective observational cohort in China has characterised over 1 100 patients across multiple cities, revealing a younger mean age and a high prevalence of chronic glomerulonephritis compared with Western cohorts. Approximately 88 % of patients dialysed via native arteriovenous fistula, yet only two-thirds achieved target phosphate levels and under 20 % maintained optimal haemoglobin, highlighting gaps in mineral and anaemia control. Substantial inter-city variation was observed in dialysis vintage, nutritional status and use of dialysis adequacy metrics such as single-pool Kt/V. These findings underscore the need for standardised practice patterns and targeted interventions for bone-mineral disorder and anaemia in diverse healthcare settings.

Dialysis Outcomes and Practice Patterns publication trend

The graph below shows the total number of articles in dialysis outcomes and practice patterns across all publications each year (not limited to Nature Index journals).

Technical terms

Haemodialysis: Extracorporeal removal of solutes and fluid via diffusion across a semipermeable membrane.

Haemodiafiltration: Combined diffusive and convective solute clearance to enhance removal of middle-molecular-weight toxins.

Peritoneal Dialysis: Use of the peritoneal membrane as a dialysing surface for continuous fluid and solute exchange.

Dialysis Vintage: Duration of time elapsed since initiation of chronic dialysis therapy.

Kt/V: Dimensionless index of dialysis dose, representing dialyser clearance (K) multiplied by treatment time (t) and divided by patient volume (V).

End-Stage Kidney Disease (ESKD): Irreversible loss of renal function requiring renal replacement therapy.

CKD-MBD: Mineral and bone disorder associated with chronic kidney disease, involving disturbances in calcium, phosphate, parathyroid hormone and bone metabolism.

References

1. Baseline data report of the China Dialysis Outcomes and Practice Patterns Study (DOPPS). Scientific Reports (2021).
2. Annual dialysis data report 2019, JSDT Renal Data Registry. Renal Replacement Therapy (2023).
3. Calculation of expected remaining lifetime of dialysis patients in Japan. Renal Replacement Therapy (2020).