Long-term prognosis of chronic hemodialysis patients is affected by dialysis adequacy; thus, evaluation of dialysis adequacy plays a key role in assessment of healthcare system in all countries. Currently, urea reduction ratio (URR) and Kt/V are applied to evaluate dialysis adequacy; however, due to the inconsistency between their results and patient outcome, their application has been questioned. Herein, we aimed at broadly reviewing the shortcomings of Kt/V index for appraisal of dialysis adequacy. For this purpose, we searched MEDLINE, EMBASE, Science direct, Cochrane Library, Scopus, and Google Scholar for relevant literature without any time or language limitations from May 2016 to February 2017. The applied keywords were "dialysis adequacy" OR "dialysis sufficiency" OR "dialysis competence" OR "dialysis efficiency". We summarized all the studies questioning the success of Kt/V index in appraisal of dialysis adequacy to investigate whether Kt/V is still an appropriate index for evaluation of adequacy of different types of dialysis. The results of this study revealed that Kt/V is not the best criterion and one cannot be assured of dialysis adequacy solely based on this criterion.Keywords: Dialysis Adequacy, Kt/V, Dialysis Sufficiency, Dialysis Competence, Dialysis Efficiency
ContextChronic kidney disease (CKD) is a progressive and irreversible malfunction with various systemic adverse effects (1). End stage renal disease (ESRD) is a condition in which the patient requires dialysis or renal transplant to survive. Annually, thousands of people die of ESRD (2). Change in parameters associated with lifestyle, such as hypertension and diabetes, can explain the rising incidence rate of this disease (3). The prevalence of this disease is on a growing trend in the developed and developing countries (4). According to the national health organization of America reports, the prevalence rate of this debilitating disease has increased by 600% during 1980 and 2009 (5).In Iran, prevalence and incidence of ESRD is also on the rise (6), so prevalence and incidence of ESRD, with an increase of 460 times, have risen from 137 per 1,000,000 cases in 1997 to 238 cases in 2000 and to 436 cases in 2007 (7, 8). Based on a report by the management center for transplantation and special diseases, approximately 33,000 patients received alternative therapies for kidney during 2007 (8, 9).Hemodialysis replaces some of the renal functions in ESRD patients to remove waste products and extra fluids from the blood when the kidneys cannot function adequately (10, 11). Thus, with higher dialysis adequacy, the patient would have a better health status and would suffer less from adverse effects of renal failure (12). Long-term prognosis of hemodialysis patients is affected by dialysis adequacy (13). Dialysis adequacy is considered a predictor of patient mortality and primary outcomes (14). The patients undergoing dialysis with high adequacy live as long as those receiving kidney transplant (15, 16).The Kt/V index, as a criterion for inve...