QUANTIFICATION OF HEMODIALYSIS - ANALYSIS OF METHODS AND THE RELEVANCE TO PATIENT OUTCOME

Quantification of small solute removal in patients treated with chroni c hemodialysis (HD) is widely used to assess the adequacy of both pres cribed and delivered treatment, Four recent American studies have demo nstrated a clear relationship between delivered dialysis dose and outc ome in chronic HD patients, Although a number of HD quantification met hods have been proposed, no specific technique is accepted as the gold standard at present, The primary goal of this review is to provide a critical assessment of the four recently published studies relating HD outcome to dialysis dose, As these studies involved a variety of ther apy quantification methods, a review of the most common techniques use d to measure dialysis dose is also presented, In addition, two unresol ved issues that have recently come to the forefront of HD quantificati on are presented, These issues are the role of dialysate-side measurem ent of HD dose and the potential limit of the beneficial effect of inc reasing HD dose on clinical outcome, Finally, the overall design of th e NIH HD adequacy trial is discussed, with particular attention paid t o the kinetic methods used in the study.