Duration and Adequacy of Dialysis Overview: The Science Is Easy, the Ethic Is Difficult
Kjellstrand, Carl M.
Asaio Journal. 1997 May-Jun; 43(3): 220-224.
Because of physiologic, technical, and practical limits, short dialysis is probably associated with higher mortality when compared with longer dialysis, even when dialysis efficiency is maintained with a proportionately higher clearance. The optimal dialysis efficiency measured as KT/V (or better expressed as mean standardized urea clearance in ml/min) for hemodialysis, remains unknown, but it is not unreasonable to assume that either a KT/V of 3 or a mean standardized urea clearance of 30 ml/min is optimal, and certainly better than the presently used KT/V of 1.2 to 1.8. To achieve KT/Vs on this order, a 70 kg patient will need at least 7 hours of dialysis 3 times per week. This gives rise to an ethical problem: Should one give many patients short dialysis, or fewer patients longer dialysis? This is a question to which no easy ethical solution can be found.
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