Patient assessments of adequacy of dialysis and protein nutrition

Nephrologists closely monitor biochemical measurements of adequacy of dialysis and protein nutrition, but little is known about how patients assess adequacy. We sought (1) to determine how hemodialysis patients assess adequacy and (2) to compare patient assessments with objective measures of adequacy. We performed a cross-sectional interview study of 145 patients from two chronic hemodialysis units. Using a structured questionnaire, we asked subjects to assess the amount of dialysis and protein nutrition they were getting. Objective measures of amount of dialysis (Kt/V) and protein nutrition (albumin) were obtained from chart abstraction. We found that only 5% of all subjects thought they were getting less dialysis than they needed, yet 41% were actually receiving inadequate dialysis (Kt/V <1.2). Even among the 60 subjects with Kt/V less than 1.2, only 5% thought they were getting less dialysis than they needed. Similarly, 21% of all subjects thought they were getting less protein nutrition than they needed, yet 28% had inadequate protein nutrition levels (albumin <3.5 g/L). Even among the 41 subjects with albumin less than 3.5 g/L, only 20% thought they were getting less protein nutrition than they needed. In conclusion, patient assessments of adequacy differ greatly from the objective measures that nephrologists use to assess adequacy. Most patients with Kt/V less than 1.2 or albumin less than 3.5 g/L think they are getting adequate dialysis and protein nutrition. Understanding how patients assess adequacy may be an important step in developing interventions to improve the adequacy of dialysis and protein nutrition.