Achieving dialysis adequacy: A global perspective

Abstract

Attempts to quantify the performance of dialysis therapy had started even before maintenance dialysis became widely available. Initial efforts in 1950s were centered around measuring the ability of a dialyzer to remove the solute mass, leading to coinage of the terms "clearance" and "dialysance". 1 The concept of adequacy, or the understanding that patient outcome was linked to performance of dialyzer, gathered pace in the 1970s on the basis of work by Babb and Scribner (square-meter hour hypothesis), Kopp (liter-kilogram concept) and Kjellstrand (time/ kg or liter). 1 It is interesting to note that all of these early models include time on dialysis as an important component, with the understanding that removal of "middle molecules" had important bearing on outcomes. The relative importance of, and interaction between, diffusion and ultrafiltration was also starting to be understood in the 1970s. The decades of 1980s and 1990s were heavily influenced by work of Gotch and Sargent who used mathematical modeling of urea kinetics on data from the National Cooperative Dialysis Study (NCDS) and that popularized the concept Kt/V urea (originally articulated by Babb-Scribner) of an adequate normalized dialysis dose (ie, dialyzer clearance of urea (K) and treatment time (t) with respect to its distribution volume (V)). 2 Daugirdas and Tattersall created simple equations that lent themselves to automatic calculation. In parallel, Lowrie came up with an alternate metric-urea reduction ratio (URR), but all of these continued to highlight the primacy of small solute clearance. The term "dialysis adequacy" was mostly used to denote "an appropriate dialysis dose" reflecting urea clearance. 3,4 The inadequacy of this measure was recognized relatively early, in particular from the work of Teschan and colleagues that led to the currently accepted standard dialysis frequency-thrice a week. They also

The Burden of Caregivers of Patients Undergoing Hemodialysis

“…So the need for dialysis will increase over time. However, there is a lack of information about the number of dialysis patients in Uttarakhand state [4]. Caregivers often receive little attention, and the main focus has remained on the patients.…”

Study on the Clinical Implications of NLR and PLR for Diagnosing Frailty in Maintenance Hemodialysis Patients and Their Correlations with Patient Prognosis

“…The incidence of frailty increases with age and can reach 21.5% among the elderly in China [ 14 ]. Dialysis adequacy refers to the removal of excess water and toxins from the patient's body through HD to reach a comfortable state [ 15 ]. In a domestic study involving 120 MHD patients, dialysis adequacy was tested, and it was found that MHD patients with more adequate dialysis (i.e., urea clearance index ≥1.2) had a lower probability of muscle content decline and were less prone to frailty [ 14 ].…”

“…In addition, malnutrition and sarcopenia are common complications in MHD patients. Evidence has shown that MHD patients with hypoproteinemia are more susceptible to frailty, and the SA level is negatively correlated with the degree of frailty [ 15 ]. Another study holds that sarcopenia is the core mechanism of frailty, and GS, WS, and MAMC are important indexes to diagnose and evaluate sarcopenia [ 16 , 17 ].…”

A novel method to rapidly calculate the urea clearance index and urea reduction rate based on parameters obtained during hemodialysis

“… 1 The efficacy of HD is closely associated with patient survival time and quality of life. 2 , 3 The urea clearance index (Kt/V, where K = dialyzer clearance of urea, t = dialysis time, and V = volume of distribution of urea) and urea reduction rate (URR) are the 2 most important indices for evaluating the adequacy of dialysis. 3 , 4 These calculations are based on blood urea nitrogen (BUN) concentrations taken before and after dialysis.…”

“… 2 , 3 The urea clearance index (Kt/V, where K = dialyzer clearance of urea, t = dialysis time, and V = volume of distribution of urea) and urea reduction rate (URR) are the 2 most important indices for evaluating the adequacy of dialysis. 3 , 4 These calculations are based on blood urea nitrogen (BUN) concentrations taken before and after dialysis. The classical method (CLM) of obtaining these values, based on the second-generation Daugirdas formula, 5 , 6 is the most widely used method in clinical practice.…”