| [ Summary ] |
An index of dialysis dose is the fractional clearance of urea, which is commonly expressed as Kt/V. Recommended minimal targets for dialysis adequacy have been defined by both American and European guidelines. The Hemodialysis (HEMO) study showed that greater urea removal nonsignificantly reduces the relative risk of mortality and that also high-flux hemodialysis was associated with a nonsignificant reduction, although DOPPS data shows that ultrafiltration rate is the key factor for session tolerance and longer dialysis treatment time reduces dramatically the incidence of mortality. Kidney Disease Improving Global Outcomes (KDIGO) global guideline aims to base its guidelines on an extensive and systematic analysis of the available evidence.
On the other hand, Local guidelines provide education and an important framework for local clinical practice. However, Kt/V must not be Golden standard, leading to reconsideration of what may be the optimal dialysis modality. |