Hemodialysis has come a long way since its early days and is a life sustaining therapy for millions of people with end-stage kidney disease throughout the world. Although thrice weekly hemodialysis remains the most common form of renal replacement therapy, other therapies such as more frequent, prolonged dialysis modalities have seen a rise recently. In this review, we compare and contrast methods for measuring the dialysis dose, with a focus on small molecule clearance (Kt/Vurea) among various dialysis modalities. We also describe newer on-line methods to measure dialysis and limitations to current adequacy measurement. Distinguishing dialysis adequacy from adequate treatment of the patient is also emphasized.
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