Dialysis has come a long way since its invention in the 1940, in this session we will explore the dialysis evolution. Newer dialysis machines are more compact, user-friendly and efficient, and provide better monitoring. Modern dialyzer membranes are designed to more effectively remove larger molecules, enhance toxin clearance, and reduce inflammation, leading to better overall patient outcomes. Additionally, there have been improvements in vascular access management, medications taken by patients with ESKD and a push to make hemodialysis more accessible for patients to perform at home. Hemodiafiltration (HDF) is a renal replacement therapy that combines both hemodialysis and hemofiltration. A large amount of fluid is removed via hemofiltration, and smaller waste molecules are cleared via hemodialysis, allowing for a more thorough cleaning of the blood. HDF mimics more of the kidney’s natural filtration process. Research has shown that HDF may be associated with improved long-term outcomes.