Chapter 41
Dialysis Dose and Adequacy for Hemodialysis
Brendan Smyth,
Carmel M Hawley,
Meg Jardine,
Brendan Smyth
Department of Renal Medicine, St George Hospital, Kogarah, Australia
NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
Search for more papers by this authorCarmel M Hawley
Department of Nephrology, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
Search for more papers by this authorMeg Jardine
NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
Department of Nephrology, Concord Repatriation General Hospital, Australia
Search for more papers by this authorBrendan Smyth,
Carmel M Hawley,
Meg Jardine,
Brendan Smyth
Department of Renal Medicine, St George Hospital, Kogarah, Australia
NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
Search for more papers by this authorCarmel M Hawley
Department of Nephrology, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
Search for more papers by this authorMeg Jardine
NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
Department of Nephrology, Concord Repatriation General Hospital, Australia
Search for more papers by this authorBook Editor(s):Jonathan C. Craig MBChB, DipCH, MMed(Clin Epi), PhD, FAHMS,
Donald A. Molony MD,
Giovanni F.M. Strippoli MD, PhD, MPH, MM (Epi),
Jonathan C. Craig MBChB, DipCH, MMed(Clin Epi), PhD, FAHMS
Matthew Flinders Distinguished Professor Vice President and Executive Dean
College of Medicine and Public Health, Flinders University, Adelaide, Australia
Search for more papers by this authorDonald A. Molony MD
Professor of Medicine Distinguished Teaching Professor of the University of Texas System
Division of Renal Diseases and Hypertension AND Center for Clinical Research and Evidence-based Medicine, McGovern Medical School University of Texas, Houston, TX, USA
Search for more papers by this authorGiovanni F.M. Strippoli MD, PhD, MPH, MM (Epi)
Professor of Nephrology Adjunct Professor of Epidemiology
Department of Emergency and Organ Transplantation – University of Bari, Bari, Italy
School of Public Health, University of Sydney, Sydney, NSW, Australia
Search for more papers by this authorFirst published: 18 November 2022
Summary
Dialysis is a laborious and expensive process for both patients and healthcare providers. This chapter considers dialysis adequacy as a multidimensional concept, incorporating a comprehensive assessment of the patient's needs, symptoms, and goals, and within which minimum urea-clearance standards provide a useful, but far from definitive, benchmark. The chapter provides assessment of level of evidence for intensity of hemodialysis therapy. Dialysis therapy must be tailored to fit the patient. The chapter presents an indication of the information required to facilitate an adequacy assessment. It provides an introduction to principles of urea kinetic modeling as this remains a useful component of the adequacy assessment. Longer treatment times are associated with longer life expectancy. The evidence base for dialysis dosing is limited, with no high-quality systematic reviews published that include all recent studies. Dialysis adequacy must be assessed on an individual basis with patient needs being defined in line with patient goals and circumstances.
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