The Acute Dialysis Quality Initiative--part III: solute control (treatment dose)

One of the most important advances in chronic dialysis therapy was the establishment of a method for determining delivered dose. There has been a meaningful relationship between higher delivered dialysis dose and improved outcome in the end-stage renal disease (ESRD) patient. The question of establishing a similar dialysis dose method in the patients with acute renal failure (ARF) is hampered with several specific issues to the ARF patient. The state of catabolism in ARF is not eubolic, but rather catabolic. Patient volume or urea space is highly variable among ARF patients and even within the same patient over very short periods of time. Finally, there are comorbidities that play a major role in both the ultimate patient outcome and the generation of many of the indicators used in dialysis dose generation. Thus, the mere transition from the ESRD dose methodology, where these issues are quite stable, to the ARF population is not an easy process. It is, however, of utmost importance that a dose methodology be established. Only after will we be able to address the dose/outcome relationship. The current article reviews what is known, what is theorized and what needs to be established in an effort to determine a dialysis dose methodology in ARF patients.