抄録
The issue of optimization of hemodialysis was once discussed in the light of middle molecule as a sole possible target of dialysis modality determination. However, our experimental and clinical results obtained in the past which assayed the effects of both small and middle molecular fraction were contrary to the hypothesis; It can never be a sole parameter. On the other hand, a weak neurotoxin capable to cause peripheral neuropathy exists in a small group of patients. For this kind of patient, a strategy exclusively against middle molecular fraction such as direct hemoperfusion can be valid. Recent interest on biocompatibility is also proposing new aspect on adequacy of hemodialysis. The idea of biocompatibiltiy is essentially a function of multiple parameters. For example, a combination of synthetic polymer membrane, l-ray sterilization, hypernatremic bicarbonate dialysate seems to a good choice among various modalities. Howevere, since pathophysiological conditions of dialysis patients differ from case to case, modality of dialysis should be individualized. There is no one best modality.
