Currently used formulas to measure dialysis adequacy such as KT/V and URR failed to reflect the actual medical conditions and the clinical outcome for dialysis patients. Patients still having multiple intradialytic complications such as cramps, nausea, vomiting, headaches, fatigue, hypotensive episodes during dialysis, hangover after dialysis, patients remain fluid overloaded with subsequent poor blood pressure control, left ventricular hypertrophy, and high cardiovascular mortality.
Dialysis adequacy measures did not address the urea rebound concept and middle molecule clearance. If Kt/Vurea and URR are the only measures of dialysis adequacy, it is much easier to achieve high Kt/V in small patients even with reduced dialysis time. The long term effect of middle and large molecules are fatal. They are responsible for anemia, arteriosclerosis, chronic inflammation, increase mortality, malnutrition and dialysis amyloidosis.
Convective Transport Increases middle and large molecule clearances reduces the mortality by 10% and lowers morbidity by 40% in terms of carpal tunnel syndrome surgery. Membrane biocompatibility and good quality of dialysate helps in improving malnutrition, inflammation, atherosclerosis and anemia.
Hemodiafiltration (HDF) as an alternative to conventional hemodialysis that allows online sterile fluid production has proven to be economically viable.
The current norm of thrice-weekly scheduling was borne of pragmatism rather than evidence. There is evidence of an increased rate of sudden and cardiovascular death after the "long gap" (Friday to Monday and Saturday to Tuesday) in USRDS data
Finally recommendations for optimal dialysis treatment will be explored in depth during the presentation.