In this session join Drs. Peter Kotanko, Research Director of the Renal Research Institute & Jeroen Kooman, Professor at Maastricht University in the Netherlands, discuss the pathophysiology of hypoxemia and hypoxia in patients on dialysis will be discussed, as well as the mechanisms by which these phenomena are related to adverse outcomes. The maladaptive responses in patients on dialysis will be discussed in the context of comparative physiology, with the example of Sherpa, which shows a highly adaptive response to ambient hypoxia. It will also be discussed how lessons from comparative physiology might be of potential benefit to patients on dialysis.