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Journal de Pharmacie Clinique

General presentation of the two main dialysis methods Volume 30, numéro 4, Décembre 2011

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Beside renal transplantation, hemodialysis and peritoneal dialysis are the two available methods of renal replacement therapy. Many variants and techniques of treatments are attached to these two lines of therapy. For example, hemofiltration and hemodiafiltration online are techniques related to hemodialysis while automated peritoneal dialysis with its variants are modalities of peritoneal dialysis. The aim of these 2 lines of therapy is the same, that is to remove accumulating excessive amounts of uremic toxins in patient plasma. Renal replacement therapy at the end stage renal disease, including kidney transplantation is a significant public health problem in France. It concerns more than 1.000 patients per million populations with a total annual cost of more than 4 billion euros. Dialysis modalities are constantly varying in adaptation to efficiency issues, patient's comfort and choices. The basic principal of dialysis remains the same across all methods and modalities, that is to create a contact between 2 aqueous media (blood and dialysate) across a selective semi permeable membrane. This contact permits exchanges of solvents and solutes between the 2 fluids on both sides of the membrane. Peritoneal dialysis uses a natural membrane, the peritoneum, for these exchanges, while hemodialysis depends on synthetic membranes. The ultimate goal of any dialysis method is to re-establish the homeostasis of body fluids, through normalizing various ionic and toxin concentrations. Both hemodialysis and peritoneal dialysis have similar patients’ morbidity and mortality results. Peritoneal dialysis, however since it is dependent on the viability of a biological membrane has a limited duration and all patients end up needing either transfer to hemodialysis or transplantation. All renal replacement therapy methods should be considered complementary not exclusive, more so regarding the much improved longevity of both patients and techniques. In other terms, care givers should prospect for years or even decades of management of end stage renal failure patients and a possible need to shift between the major three renal substitution methods.