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Monitoring dialysis adequacy: history and current practice

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Abstract

Dialysis adequacy for pediatric patients has largely followed the trends in adult dialysis by judging the success or adequacy of peritoneal or hemodialysis with urea kinetic modeling. While this provides a starting point to establish a dose of dialysis, it is clear that urea is only part of the picture. Many clinical parameters and interventions now have been identified that are just as impactful on mortality and morbidly as urea clearance. As such, our concept of adequacy is evolving to include non-urea parameters and assessing the impact that following an “adequate therapy” has on patient lives. As we move to a new era, we consider the impact these therapies have on patients and how it affects the quality of their lives; we must take these factors into consideration to achieve a therapy that is not just adequate, but livable.

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Funding

Partial financial support was received from the Children's Hospital Research Institute of Manitoba for publication costs.

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Authors and Affiliations

  1. Department of Pediatrics and Child Health, University of Manitoba, Rady College of Medicine, Winnipeg, Manitoba, Canada

    Linda Ding, James Johnston & Maury N. Pinsk

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  1. Linda Ding
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  2. James Johnston
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  3. Maury N. Pinsk
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Contributions

L. Ding and J. Johnston both contributed a literature review and first draft of sections of the manuscript, and creation of the tables. M. Pinsk created the educational session and outline from which this paper was constructed, reviewed and edited the manuscript, created figures, and edited and reviewed the MCQs.

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Correspondence to Maury N. Pinsk.

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1. d; 2. b; 3. a; 4. d; 5. e

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Ding, L., Johnston, J. & Pinsk, M.N. Monitoring dialysis adequacy: history and current practice. Pediatr Nephrol 36, 2265–2277 (2021). https://doi.org/10.1007/s00467-020-04816-9

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  • DOI: https://doi.org/10.1007/s00467-020-04816-9

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