The Use of a Multidimensional Measure of Dialysis Adequacy—Moving beyond Small Solute Kinetics

Perl, Jeffrey; Dember, Laura M.; Bargman, Joanne M.; Browne, Teri; Charytan, David M.; Flythe, Jennifer E.; Hickson, La Tonya J.; Hung, Adriana M.; Jadoul, Michel; Lee, Timmy Chang; Meyer, Klemens B.; Moradi, Hamid Reza; Shafi, Tariq; Teitelbaum, Isaac; Wong, Leslie P.; Chan, Christopher T.

doi:10.2215/cjn.08460816

Cited by 72 publications

(72 citation statements)

References 94 publications

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“…A better understanding of patient‐reported outcomes may allow kidney care practitioners to facilitate a patient‐centered approach to dialysis modality selection . Ongoing patient involvement in research may help set research priorities for the future and this may facilitate more effective communication between health care professionals and patients in education surrounding dialysis treatment options.…”

Section: Our Opinionmentioning

confidence: 99%

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Dialysis modality and survival: Done to death

Trinh

Chan

Perl

2018

Seminars in Dialysis

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The debate surrounding whether peritoneal dialysis or hemodialysis is associated with differential survival continues as the numerous comparative studies over the past 3 decades have yielded conflicting results. Findings have also evolved over time in the setting of changing patient characteristics, advances in dialytic technologies, and the use of more robust statistical and epidemiologic approaches. Here, we will critically review the body of evidence, both historical and contemporary, comparing survival across dialysis modalities. Significant limitations of the observational nature of the current literature will be highlighted given that no adequately powered randomized controlled trials exist. Given the lack of consistency and limitations of current studies, coupled with the poor survival across both modalities, we can likely conclude that survival comparisons between both modalities do not appreciably differ. Hence, the choice of dialysis modality should not be dictated by survival comparisons, but rather be based on an individualized and informed decision making that places patient preference and lifestyle considerations at the forefront, while integrating medical factors and availability of resources and support. The emphasis of future research should move beyond survival outcomes when comparing dialysis modalities, and instead be redirected to patient-endorsed and patient-reported outcomes.

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Section: Our Opinionmentioning

confidence: 99%

“…A better understanding of patient-reported outcomes may allow kidney care practitioners to facilitate a patient-centered approach to dialysis modality selection. 97…”

Section: Quality Of Life and Patient-reported Outcomesmentioning

confidence: 99%

Dialysis modality and survival: Done to death

Trinh

Chan

Perl

2018

Seminars in Dialysis

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“…Interestingly, a Chinese study found an association between sp Kt / V and LVMI in HD patients . These measures are easily performed, although their overall usefulness as surrogate markers for cardiovascular risk need to be more accurately quantified to dictate guidance regarding the frequency of measurement and appropriate targets …”

Section: The Elephants In the Roommentioning

confidence: 99%

Should we look beyond Kt/V urea in assessing dialysis adequacy?

Jones

Bargman

2018

Seminars in Dialysis

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Since the advent of maintenance dialysis therapy, our interpretation of what adequate dialysis really is has broadened and become more controversial. This is not only due to our changing and aging dialysis population but also to our evolving knowledge base. As nephrologists, we strive to achieve both quality and (often) quantity of life for our patients and we feel reassured when we have a quantifiable marker to show for our efforts. However, we suggest that adequate dialysis reaches far beyond the realms of attaining a particular biochemical result. Dialysis adequacy should encompass a more comprehensive assessment of patient well-being. This metric could comprise quality of life and patient-specified goals, sufficient small solute and middle molecule clearance, optimal blood pressure control, and effective bone-mineral balance, all in the context of minimizing mortality and morbidity, and a livable dialysis regimen for the patient.

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“…Classically measures of dialysis adequacy since have been based on small solute clearance using urea and creatinine and are defined as the minimum urea clearance and nutritional intake that prevent adverse outcomes [1]. …”

Section: Introductionmentioning

confidence: 99%

Assessment of dialysis adequacy: beyond urea kinetic measurements

Rees

2018

Pediatr Nephrol

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Adequacy of dialysis is a term that has been used for many years based on measurement of small solute clearance using urea and creatinine. This has been shown in some but not all studies in adults to correlate with survival. However, small solute clearance is just one minor part of the effectiveness of dialysis and in fact ‘optimum’ dialysis, rather than ‘adequate’ dialysis is what most paediatric nephrologists would want for their patients. Additional ways to assess the success of dialysis in children would include dialysis access complications and longevity, preservation of residual kidney function, body composition, biochemical and haematological control, nutrition and growth, discomfort during the dialysis process and psychosocial adjustment including hospitalisation and school attendance. These criteria need to be balanced against a dialysis programme that has the least possible adverse effects on quality of life.

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The Use of a Multidimensional Measure of Dialysis Adequacy—Moving beyond Small Solute Kinetics

Cited by 72 publications

References 94 publications

Dialysis modality and survival: Done to death

Dialysis modality and survival: Done to death

Should we look beyond Kt/V urea in assessing dialysis adequacy?

Assessment of dialysis adequacy: beyond urea kinetic measurements

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