Adequacy of dialysis.

Abstract

(1) There is no single measurement of adequacy in dialysis available now, and there likely never will be. (2) With present knowledge, it is rational to model patients for removal of both small and middle molecules. Minimum weekly clearances for urea and for a middle molecule the size of Vitamin B12 should be 120 and 30 liters per week per 1.73 m2 respectively. (3) In prescribing a dialysis treatment, a Kt/v urea greater than 1 should be targeted, a value of under 0.8 is unacceptable. (4) Attention to the nutritional status of the patient is important, and one should strive for a PCR of 1.1 to 1.3 g/kg/day. (5) Studies on living cells (for example, platelets) and systems (for example, CNS function) are valuable if there is doubt as to the patient's status. (6) Assessments of treatment stresses and quality of life should be used in monitoring dialysis patients. (7) In clinical trials of different treatment methods, it is important to equate findings to solute clearance profiles and to include studies on functions of cells or systems and to measure the impact of the treatment upon quality of life.