Choosing a dialyzer: What clinicians need to know.

The objectives of hemodialysis have moved from the diffusive clearance of small molecular weight uremic toxins and achieving dialyzer urea adequacy targets to emphasis on improving clinical outcomes in end stage renal failure patients by increasing larger sized uremic toxin clearance. Clinical emphasis in the last few decades has focused on increasing middle molecule weight toxin clearance by hemodiafiltration. Although long-term data is still lacking, short-term outcomes appear promising. Advancements in nanotechnology have now introduction a new generation of medium cut-off membrane dialyzers which allow diffusive clearance of similar middle molecular weight uremia toxin clearance as hemodiafiltration, without increased albumin losses. As these dialyzers have only recently been introduced into clinical practice, no long-term outcomes are available to determine the relative benefits or advantages of this approach. As dialyzers are now designed to maximize diffusive or convective clearance, or provide a combination, then clinicians can now choose dialyzers tailored to the individual patient needs depending on clinical circumstances. We review the key important features in choosing a dialyzer for patients with end stage renal failure and acute kidney injury.