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Dialysis adequacy indices (Master thesis)

Κουτουκίδου, Αναστασία/ Koutoukidou, Anastasia

Chronic Kidney disease is a major public health problem characterized by the decrease of renal function and the resulting homeostatic disturbances. It is a major cause of mortality and morbidity, primarily from its cardiovascular complications. The most common predisposing factors for chronic kidney disease are metabolic syndrome, hypertension and diabetes mellitus. These conditions display a rising incidence in the west world so the incidence of chronic kidney disease is expected to rise too. During the first stages of the disease a conservative approach is possible with lifestyle and nutrition changes and elimination of the predisposing risk factors, drug therapy is also an option. Unfortunately,a significant portion of the patients will require at some point some kind of renal replacement therapy or renal transplantation. Dialysis is a very common modality of renal replacement with thousands of new patients in Greece annually. Hemodialysis transformed from a high risk procedure indicated only for acute renal failure to a relatively safe chronic treatment for patients with chronic kidney disease with impressive effect on survival and quality of life for these patients. The technological advancements made this procedure an essential component of day to day clinical practice of treating chronic kidney disease patients. Outstanding achievements that led to this were the improvement of the hemodialysis machines, the arteriovenous fistulas and the better understanding of the disease pathophysiology. Soon after the initial installment of hemodialysis in clinical practice questions started to emerge regarding the correct “dose” of the treatment. The time the patient had to maintain connected with the dialysis machine the frequency of treatment or the goals of the treatment remained ambiguous. A major barrier for the identification of the ideal dialysis session is the poor understanding of the uremic syndrome. Urea was the first molecule recognized as a possible biomarker for the evaluation of the dialysis session effect on the uremic syndrome. This assay examines the emergence of the term dialysis adequacy through the years, the development of urea kinetics and the first randomized controlled clinical trials that pinpointed the role of urea kinetics in measuring dialysis adequacy and the application of all these in clinical practice through official recommendations and guidelines and modern solutions like real time adequacy monitoring.