The use of a multidimensional measure of dialysis adequacy—moving beyond small solute kinetics

Jeffrey Perl, Laura M. Dember, Joanne M. Bargman, Teri Browne, David M. Charytan, Jennifer E. Flythe, Latonya J. Hickson, Adriana M Hung, Michel Jadoul, Timmy Chang Lee, Klemens B. Meyer, Hamid Moradi, Tariq Shafi, Isaac Teitelbaum, Leslie Wong, Christopher T. Chan

Research output: Contribution to journalReview articlepeer-review

27 Scopus citations


Urea removal has become a key measure of the intensity of dialysis treatment for kidney failure. Small solute removal, exemplified by Kt/VUREA, has been broadly applied as a means to quantify the dose of thrice weekly hemodialysis. Yet, the reliance on small solute clearances alone as a measure of dialysis adequacy fails fully to quantify the intended clinical effects of dialysis therapy. This review aims to (1) understand the strengths and limitations of small solute kinetics as a surrogate marker of dialysis dose, and (2) present the prospect of a more comprehensive construct for dialysis dose, one that considers more broadly the goals of ESRD care to maximize both quality of life and survival. On behalf of the American Society of Nephrology Dialysis Advisory Group, we propose the need to ascertain the validity and utility of a multidimensional measure that moves beyond small solute kinetics alone to quantify optimal dialysis derived from both patient-reported and comprehensive clinical and dialysis related measures.

Original languageEnglish (US)
Pages (from-to)839-847
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Issue number5
StatePublished - 2017


  • Dialysis Physiology
  • Dialysis dos
  • Patient Reported Outcomes
  • Urea Kinetics

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation


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