| Theme | Imagination and Evaluation of the Dialysis Dose | |
|---|---|---|
| Title | Dialysis dose development | |
| Publish Date | 2003/09 | |
| Author | Masashi Suzuki | Kidney Cencer of Shinraku-En Hospital |
| [ Summary ] | The ultimate aim of dialysis renal replacement therapy is longer survival with higher QOL and a lack of comorbidity. Adequate dialysis, minimal dialysis dose for a positive outcome from optimal dialysis, and maximal dose, above which no increased advantage could be expected, have been classified. In the issue of target solutes to be removed, urea as well as creatinin levels lower than 500 Da. Next in importance were mid level molecules of 500 to 5,000 Da. In the 1970s, the prospective randomized National Cooperative Dialysis Study (NCDS) revealed that lower maintenance plasma urea levels are advantageous for longer survival, Kt/V (with a single-pool model), as the concept for dialysis dose was proposed. Dialysis amyloidosis was identified in 1985 and Beta2-microglobulin of 11,800 Da was identified as a precursor protein. However, in 1997, NKF/DOQI recommended a minimum hemodialysis dose of at least Kt/V=1.2, with a urea reduction rate of 70%. However, a recent HEMO Study (the prospective randomized cohort study started in 1995) revealed that the higher dialysis dose, prescribed by Kt/V (in a double-pool model), is favorable for longer survival, as seen in the results of NCDS. However, no advantage was seen with higher flux membranes. The cooperative cohort study in the USA, the European community, and Japan showed that the 5-year survival rate in the USA is still lower than elsewhere. |
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