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Special Feature
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Dialysis at a Crossroads: 50 Years Later

Thomas Parker, Raymond Hakim, Allen R. Nissenson, Theodore Steinman and Richard J. Glassock
CJASN December 2010, CJN.08450910; DOI: https://doi.org/10.2215/CJN.08450910
Thomas Parker III
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Raymond Hakim
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Allen R. Nissenson
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Theodore Steinman
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Richard J. Glassock
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Abstract

The ability to offer repetitive hemodialysis for treatment of chronic kidney failure has now reached its half-century anniversary. Although millions of patients have benefited from this life-extending procedure, current results in the United States have now stagnated with only small annual improvements in survival and continued high hospitalization rates. Recognition that this stagnation may be, at least in part, the result of inadequacies of current and prior paths utilized in dialysis treatment has led to the concept that dialysis therapy is at a crossroads and that new paths need to be articulated, explored, and applied. This article proposes some of these new paths and their rationale. Two elements of the new paths are emphasized: avoidance of indwelling catheters for vascular access and meticulous attention to control of extracellular volume and mitigation of left ventricular hypertrophy and fibrosis. It is postulated that progress in these two areas, along with continued attention to other elements embodied in the new and old paths, will unlock the stagnation in outcomes of dialysis therapy of end-stage kidney failure and allow it to realize its full potential of prolonging life and alleviating disability.

  • Copyright © 2010 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 16 (1)
Clinical Journal of the American Society of Nephrology
Vol. 16, Issue 1
January 07, 2021
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Dialysis at a Crossroads: 50 Years Later
Thomas Parker, Raymond Hakim, Allen R. Nissenson, Theodore Steinman, Richard J. Glassock
CJASN Dec 2010, CJN.08450910; DOI: 10.2215/CJN.08450910

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Dialysis at a Crossroads: 50 Years Later
Thomas Parker, Raymond Hakim, Allen R. Nissenson, Theodore Steinman, Richard J. Glassock
CJASN Dec 2010, CJN.08450910; DOI: 10.2215/CJN.08450910
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More in this TOC Section

  • Serious Illness Conversations in ESRD
  • Use of Causal Diagrams to Inform the Design and Interpretation of Observational Studies: An Example from the Study of Heart and Renal Protection (SHARP)
  • Climate Change and the Emergent Epidemic of CKD from Heat Stress in Rural Communities: The Case for Heat Stress Nephropathy
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Cited By...

  • Systems Thinking and Leadership: How Nephrologists Can Transform Dialysis Safety to Prevent Infections
  • How the ESRD Quality Incentive Program Could Potentially Improve Quality of Life for Patients on Dialysis
  • The Medical Director and Quality Requirements in the Dialysis Facility
  • Improving Outcomes for ESRD Patients: Shifting the Quality Paradigm
  • Comparison of Hospitalization Rates among For-Profit and Nonprofit Dialysis Facilities
  • Monitoring Quality of Care at Dialysis Facilities: A Case for Regulatory Parsimony--and Beyond
  • Dialysis at a Crossroads--Part II: A Call for Action
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