Adequacy target in hemodialysis

Over the last decade, the concept of dialysis adequacy has evolved to become a component of the optimal dialysis that includes quantitative and qualitative aspects. Current method used to assess dialysis efficacy in ESRD patients relies on a targeting approach using several vital indicators. Dialysis quality is a complex and evolutionary concept that has to be viewed in a quality assurance process to improve outcomes of ESRD patients. To simplify this assessment we propose a quantitative approach including several steps: the first step consists of selecting pertinent indicators (targets) tracking specific uremia metabolic abnormalities and defining suitable range values (target values); the second step consists of defining a method checking that targeted values are achieved on a regular basis; the third step consists of validating that targeted values offer the best survival to ESRD patients; the fourth step consists of correcting treatment prescription (treatment schedule) and implementation (effective treatment delivered) to improve treatment delivery and performances. Based on this approach, it is then possible to assess the efficacy of dialysis therapy both at the individual and at the dialysis unit level, that can be easily implemented in a computerized automatic control system.