Practical guide to measuring adequacy of dialysis

Measurement of adequacy of small solute clearance on hemodialysis (HD) and peritoneal dialysis (PD) is important. In HD, formal urea kinetic modelling (UKM) is recommended because it is theoretically more accurate than the ur ea reduction ratio (URR) and because it allows prospective selection of an adequate prescription. However, the URR is simpler and has an important rol e to play. Precise attention to the methodology of sampling the post-HD blo od urea is important. In PD, both Kt/V and creatinine clearance should be m easured, and the main concerns relate to logistic problems in collection an d processing of dialysate samples. In both HD and PD, a well-defined standa rdized methodology for measuring adequacy indices should be in place in eac h dialysis unit. (C) 1999 by the National Kidney Foundation, Inc.