Stages of future technological developments in haemodialysis.

Understanding the needs of the patients, dialysis staff, and nephrologists is the first logical step in the technological development of better haemodialysis devices. This includes the understanding of large and small uraemic toxins and their removal by dialysis membranes, pathophysiology of intradialytic symptomatology, and problems associated with vascular access. Each of these areas can benefit from profiling techniques. Profiling of urea (urea kinetics), solute clearance profiles of dialysis membranes, and volume profiling are areas that are undergoing active investigations and incorporation into clinical practice. Volume profiling currently entails the monitoring of intravascular and total body fluids as well as the measurement of vascular access flow. Development of sophisticated software is necessary to integrate data from various profiling techniques into dialysis equipment in a meaningful manner in order to optimize the dialysis treatment. The ultimate benefits of these devices should take into account the medical, psychosocial, and financial aspects of various parties involved.