title: Uraemic toxins and new methods to control their accumulation: game changers for the concept of dialysis adequacy.
abstract: The current concept of an adequate dialysis based only on the dialysis process itself is rather limited. We now have considerable knowledge of uraemic toxicity and improved tools for limiting uraemic toxin accumulation. It is time to make use of these. A broader concept of adequacy that focusses on uraemic toxicity is required. As discussed in the present review, adequacy could be achieved by many different methods in combination with, or instead of, dialysis. These include preservation of renal function, dietary intake, reducing uraemic toxin generation rate and intestinal absorption, isolated ultrafiltration and extracorporeal adsorption of key uraemic toxins. A better measure of the quality of dialysis treatment would quantify the uraemic state in the patient using levels of a panel of key uraemic toxins. Treatment would focus on controlling uraemic toxicity while reducing harm or inconvenience to the patient. Delivering more dialysis might not be the best way to achieve this.
authors.affiliation: Department of Internal Medicine, Nephrology Division , Ghent University Hospital , Gent , Belgium.
authors.forename: Griet
authors.initials: G
authors.lastname: Glorieux
authors.affiliation: Department of Renal Medicine , Leeds Teaching Hospitals , Leeds LS2 7EF , UK.
authors.forename: James
authors.initials: J
authors.lastname: Tattersall
keywords: dialysis adequacy; new adequacy concepts; uraemic toxicity