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Quantitation of dialysis: historical perspective
1Nephrology Section, Medical Service, West Los Angeles DVA Medical Center, 11301 Wilshire Blvd., Los Angeles, CA 90074, USA. jshinabe@ucla.edu
Seminars in Dialysis
|August 8, 2001
Summary
Quantifying dialysis therapy has evolved significantly, with key metrics like clearance and dialysance emerging in the 1950s. Modern approaches, including urea kinetic modeling, refine treatment adequacy and patient outcomes.
Area of Science:
- Nephrology
- Biomedical Engineering
- Medical Physics
Background:
- Historical overview of dialysis quantification efforts since the 19th century.
- Contributions from various scientific disciplines in developing dialysis metrics.
- Early methods focused on mass removal and solute extraction ratios.
Observation:
- The concept of "clearance" and "dialysance" was established in 1951.
- Michaels introduced the KoA/Ro/A concept in 1966.
- Interaction of diffusion and convection in dialysis was studied by Villarroel and Jaffrin.
Findings:
- The Babb-Scribner Square meter-hour and Kt/V emerged in the 1970s for assessing dialysis adequacy.
- Urea kinetic modeling and neurofunctional tests indicated thrice-weekly dialysis is necessary.
- The National Cooperative Dialysis Study (1983) suggested Kt/V >0.8 improves survival.
- Direct Dialysis Quantification (DDQ) offers a gold standard by measuring total mass removed.
- Logarithmic equations for estimating Kt/V and eKt/V facilitate continuous quality improvement.
Implications:
- Accurate quantification of dialysis therapy is crucial for optimizing patient outcomes.
- Continuous development of metrics like Kt/V and URR aids in personalized treatment.
- Understanding dialysis mechanics is vital for managing uremic toxicity and improving patient survival.