title: Duration and adequacy of dialysis. Overview: the science is easy, the ethic is difficult.
abstract: Because of physiologic, technical, and practical limits, short dialysis is probably associated with higher mortality when compared with longer dialysis, even when dialysis efficiency is maintained with a proportionately higher clearance. The optimal dialysis efficiency measured as KT/V (or better expressed as mean standardized urea clearance in ml/min) for hemodialysis, remains unknown, but it is not unreasonable to assume that either a KT/V of 3 or a mean standardized urea clearance of 30 ml/min is optimal, and certainly better than the presently used KT/V of 1.2 to 1.8. To achieve KT/Vs on this order, a 70 kg patient will need at least 7 hours of dialysis 3 times per week. This gives rise to an ethical problem: Should one give many patients short dialysis, or fewer patients longer dialysis? This is a question to which no easy ethical solution can be found.
authors.affiliation: Department of Public Health Services, Bowman Gray School of Medicine, Winston-Salem, North Carolina 27157-1063, USA.
authors.forename: C M
authors.initials: CM
authors.lastname: Kjellstrand
mesh_terms: D004992:Ethics, Medical; D006801:Humans; D038622:Internationality; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D018579:Patient Selection; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D040841:Resource Allocation; D018570:Risk Assessment; D013997:Time Factors