ReviewKidney international2015
Once upon a time in dialysis: the last days of Kt/V?
Review in Kidney international, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
30 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Reporting of "dialysis adequacy" as an outcome in randomised trials conducted in adults on haemodialysis.PloS one · 2019Pooled it
- Comparison of Clinical Performance Between Two Types of Symmetric-Tip Hemodialysis Catheters: A Single-Centre, Randomized Trial.Cardiovascular and interventional radiology · 2023Trial
- Contribution of 'clinically negligible' residual kidney function to clearance of uremic solutes.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2020Trial
- Mortality and Practice Patterns in the MEXHEMO Hemodialysis Cohort.Kidney international reports · 2026Article
- Article
- Comparing Clearances of Polymethylmethacrylate and Polysulfone Dialyzer Membranes for Postdilution Hemodiafiltration in Patients With Kidney Failure: Protocol for a Systematic Review and Meta-Analysis.JMIR research protocols · 2025Article
- Precision Dialysis: Leveraging Big Data and Artificial Intelligence.Kidney medicine · 2024Review
- The impact of dialysate flow rate on haemodialysis adequacy: a systematic review and meta-analysis.Clinical kidney journal · 2024Article
- Adjusting dialysis dose (Kt) scaled to Body Surface Area (BSA) could be a more logical approach.PloS one · 2024Article
- Time-averaged concentration estimation of uraemic toxins with different removal kinetics: a novel approach based on intradialytic spent dialysate measurements.Clinical kidney journal · 2023Article
- The influence of hemodialysis on intracranial pressure waveform in patients with chronic kidney disease: an observational study.Sao Paulo medical journal = Revista paulista de medicina · 2023Observational
- The membrane perspective of uraemic toxins: which ones should, or can, be removed?Clinical kidney journal · 2021Review
- Deciphering the core elements around haemodialysis therapy.Clinical kidney journal · 2021Article
- Choices in hemodialysis therapies: variants, personalized therapy and application of evidence-based medicine.Clinical kidney journal · 2021Review
- Monitoring dialysis adequacy: history and current practice.Pediatric nephrology (Berlin, Germany) · 2021Article
- Serum total indoxyl sulfate and clinical outcomes in hemodialysis patients: results from the Japan Dialysis Outcomes and Practice Patterns Study.Clinical kidney journal · 2021Article
- Article
- Pharmacokinetics of Tobramycin Administered at the Beginning of Intermittent Hemodialysis Session (ESRD Study).Canadian journal of kidney health and disease · 2021Article
- Single needle hemodialysis: is the past the future?Journal of nephrology · 2020Review
- A new technique for low-volume continuous sampling of spent dialysate: a validation study.Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs · 2019Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
After its proposal as a marker of dialysis adequacy in the eighties of last century, Kt/V(urea) helped to improve dialysis efficiency and to standardize the procedure. However, the concept was developed when dialysis was almost uniformly short and was applied thrice weekly with small pore cellulosic dialyzers. Since then dialysis evolved in the direction of many strategic alternatives, such as extended or daily dialysis, large pore high-flux dialysis, and convective strategies. Although still a useful baseline marker, Kt/V(urea) no longer properly covers up for most of these modifications so that urea kinetics are hardly if at all representative for those of other solutes with a deleterious effect on morbidity and mortality of uremic patients. This is corroborated in several clinical studies showing a dissociation between removal of urea and that of other uremic toxins. In addition, randomized controlled trials showed no benefit of increasing Kt/V(urea). Finally, this parameter also hardly is evocative for metabolic or intestinal generation of toxins, for their removal by residual renal function and for the complex interaction of dialysis length with removal pattern and patient outcomes. We conclude that apart from being a baseline parameter of dialysis adequacy, Kt/V(urea) insufficiently represents all novel strategic changes of modern dialysis. Kt/V(urea) is too simple a concept for the complexities of uremia and of today's dialysis.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.