Adequacy of long-term hemodialysis

The gross mortality rates for end-stage renal disease patients treated with hemodialysis in the United States are twice those reported in Japan and Europe. This observation has prompted an inquiry into the methods used to administer dialysis therapy in these three areas of the world. It is apparent that shorter treatment time with multiple reuse of dialyzers was more frequently employed in the United States, and adequacy was more often judged by urea kinetic modeling, with the assumption that urea was a suitable surrogate for uremic toxicity. The possibility that inadequate therapy may result from too short dialysis time along with dialyzer reuse is suggested.