Addressing evidence gaps in haemodialysis care: a critical review of clinical trials, technological innovations, and implementation priorities

Abstract

Kidney failure treated with maintenance haemodialysis (HD) carries high risks of premature mortality, hospitalisation and impaired quality of life, yet important evidence gaps persist across routine HD care. The Dialysis Research Innovation Network, part of the UK Kidney Research Consortium, convened the inaugural UK Haemodialysis Research Nexus in Birmingham on 11th May 2026. There were fifty-six delegates: 22 doctors, 13 nurses, six dietitians, one renal scientist, seven people in other roles (including one patient), and seven whose role was not recorded. The meeting reviewed recent trials, emerging technologies, research methods, career development and national priorities. The NightLife trial randomised 100 participants to extended-hours in-centre nocturnal or conventional daytime HD. Recruitment was below target and consequently its primary quality-of-life result was inconclusive (adjusted mean difference 3.00 points, 95% CI -12.4 to 18.3), while exploratory secondary findings generated hypotheses concerning cognition, biochemical control and treatment burden. PISCES found fewer serious cardiovascular events with 4 g/day n-3 polyunsaturated fatty acids than placebo (0.31 versus 0.61 events per 1,000 patient-days; hazard ratio 0.57, 95% CI 0.47–0.70), without a clear all-cause mortality benefit. PHOSPHATE continues to test intensive versus liberal phosphate targets using pragmatic international infrastructure. Portable, wearable and implantable kidney-replacement technologies, patient-inclusive trial design, routinely collected data, knowledge mobilisation, mentorship and a James Lind Alliance priority-setting partnership were also discussed. The meeting identified the need for inclusive eligibility, proportionate funding, lower-burden trial delivery and outcomes that matter to patients. These proceedings are a structured report of presentations and discussion rather than a formal consensus guideline. Sustained collaboration among patients, clinicians, researchers, registries and funders is needed to convert innovation into equitable improvements in HD care.