Hemodialysis Adequacy and the Hospitalized End-Stage Renal Disease Patient—Raising Awareness


  • Nigel Suren Kanagasundaram

    1. Renal Services, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, United Kingdom
    2. Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, United Kingdom
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Address correspondence to: Dr. Nigel Suren Kanagasundaram, Consultant Nephrologist, Freeman Hospital, High Heaton, Newcastle upon Tyne NE7 7DN, UK, or e-mail suren.kanagasundaram@nuth.nhs.uk.


Assessment of hemodialysis adequacy may require different approaches for the stable, outpatient with end-stage renal disease (ESRD) and for the sick, inpatient with acute kidney injury (AKI). Variability of urea distribution volume, urea generation, and treatment schedule, for instance, complicates dialysis dosing in the latter group although progress has been made in our understanding of their needs. There is a third population, however, for whom hemodialysis dosing requirements remain unclear—the hospitalized ESRD patient. This commentary discusses the key urea kinetic differences between stable ESRD and AKI to give the context to where, on the intervening spectrum, the hospitalized ESRD patient might lie. The limited literature examining hemodialysis dosing in this population is discussed along with those outstanding questions that might form the basis of a future research agenda.