The Use of a Multidimensional Measure of Dialysis Adequacy-Moving beyond Small Solute Kinetics.
Urea removal has become a key measure of the intensity of dialysis treatment for kidney failure. Small solute removal, exemplified by Kt/Vurea,has been broadly applied as a means to quantify the dose of thrice weekly hemodialysis. Yet, the reliance on small solute clearances alone as a measure of dialysis adequacy fails fully to quantify the intended clinical effects of dialysis therapy. This review aims to (1) understand the strengths and limitations of small solute kinetics as a surrogate marker of dialysis dose, and (2) present the prospect of a more comprehensive construct for dialysis dose, one that considers more broadly the goals of ESRD care to maximize both quality of life and survival. On behalf of the American Society of Nephrology Dialysis Advisory Group, we propose the need to ascertain the validity and utility of a multidimensional measure that moves beyond small solute kinetics alone to quantify optimal dialysis derived from both patient-reported and comprehensive clinical and dialysis-related measures.
Due to the number of contributing authors, the affiliations are provided in the Supplemental Material .
Jeffrey
J
Perl
Laura M
LM
Dember
Joanne M
JM
Bargman
Teri
T
Browne
David M
DM
Charytan
Jennifer E
JE
Flythe
LaTonya J
LJ
Hickson
Adriana M
AM
Hung
Michel
M
Jadoul
Timmy Chang
TC
Lee
Klemens B
KB
Meyer
Hamid
H
Moradi
Tariq
T
Shafi
Isaac
I
Teitelbaum
Leslie P
LP
Wong
Christopher T
CT
Chan
D015415:Biomarkers / Q000097:blood; D015314:Dialysis Solutions / Q000009:adverse effects / Q000378:metabolism / Q000592:standards / Q000627:therapeutic use*; D005440:Fluid Therapy; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D007700:Kinetics; D008954:Models, Biological; D000071066:Patient Reported Outcome Measures; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000401:mortality / Q000592:standards; D011237:Predictive Value of Tests; D011786:Quality Control; D019984:Quality Indicators, Health Care; D011788:Quality of Life; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality / Q000592:standards; D016896:Treatment Outcome; D014508:Urea / Q000097:blood*
D015415:Biomarkers; D015314:Dialysis Solutions; D014508:Urea
Dialysis Physiology; Dialysis dose; Patient Reported Outcomes; Urea Kinetics