Home hemodialysis: Present state of the evidence

Abstract

disappointing results suggested that the high mortality associated with hemodialysis could not be impacted upon with relatively small increases in solute clearance. It also further questioned the rationale of focusing on Kt/V as a measure of dialysis adequacy. The mortality rate for hemodialysis patients in the U.S. is high at approximately 24.4 deaths/100 patient-years.4 The high mortality rate has persisted despite progressive increases in Kt/V over the past two decades, from 1.11 in 1991 to 1.52 in 2002.5 In addition, despite this increase in Kt/V, the complications of hypertension,6 malnutrition,7 congestive heart failure,8 and bone and mineral disorders9 have remained unacceptably high. These outcome data clearly indicate that dialysis adequacy cannot be simply measured in terms of Kt/V. Given these persistently poor outcomes