Advances in Biomarkers for Evaluating Hemodialysis Adequacy: Current Trends and Future Directions – A Narrative Review

Abstract Hemodialysis (HD) remains a vital therapy for patients with end-stage renal disease, yet assessing the adequacy of treatment poses ongoing challenges. While widely used, traditional measures such as Kt/V and urea reduction ratio focus primarily on small solute clearance and fail to capture the full spectrum of physiological changes and toxin removal during dialysis. Recent advances in biomarker research have introduced novel candidates that reflect inflammation, oxidative stress, cardiovascular risk, nutritional status, and residual renal function, offering a more comprehensive evaluation of dialysis adequacy. This narrative review discusses current trends in biomarker development, their clinical relevance, and the potential integration of these markers into personalized HD care. The review also highlights future directions for improving dialysis monitoring and patient outcomes through biomarker-driven strategies.