Technical requirements for rapid high-efficiency therapies.

Significant reductions in treatment time are possible with rapid high-efficiency hemodialysis and hemodiafiltration, provided the therapies are implemented so as to maintain adequacy of solute and fluid removal without compromising patient comfort. The key technical elements necessary for such implementation include high blood flow rates, higher efficiency dialyzers/diafilters, ultrafiltration control systems, and bicarbonate as the buffer source. In addition, hemodiafiltration requires schemes to ensure sterility and nonpyrogenicity of the infusion fluid and appropriate balancing of the rates of ultrafiltration and reinfusion. In general, rapid high-efficiency therapies are technically more complex than standard therapy, and rapid hemodiafiltration appears to be more complex than rapid hemodialysis. The technology required for rapid hemodialysis currently exists, but it needs to be fine-tuned and integrated for routine application.