Dialysis therapy: Concept evolution and update

End-stage renal disease (ESRD) is the most severe stage of chronic kidney disease. Dialysis, one of the renal replacement therapy, provides life-saving therapy for the patients with ESRD. It is paramount to improve disease outcome and quality of life while performing dialysis. According to previous studies among hemodialysis (HD) patients, the results didn't support to initiate HD at specific timing (early vs late initiation). In addition, there was no clear evidence to improve survival rate through an increase of HD dose, intensity or frequency. Although dialysate composition carries weight to the cardiovascular system, the relationships between various dialysate compositions and patient outcomes remain to be elucidated. For peritoneal dialysis (PD), peritoneal dialysis solutions other than glucose-based ones, Icodextrin or biocompatible peritoneal dialysis solutions, may be benefit for fluid control and preservation of peritoneal membrane function, and preventing encapsulating peritoneal sclerosis. About the comparison between dialysis modalities (PD vs HD), there is no significant difference between HD and PD in terms of life expectancy, quality of life and quality-adjusted life expectancy when analyzing the Taiwanese National Insurance Database and dialysis-related cohorts; however, PD is more cost-effective than HD.