Dialysis Modality, Adequacy and the ESRD Quality Incentive Program Score

Small solute clearance currently is an influential metric in the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP). Studies from the 1980s observed that higher blood urea nitrogen values in hemodialysis patients were associated with higher morbidity and mortality 1,2,3 as well as associations between higher urea reduction ratio and lower mortality4. Accordingly, the 2015 Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines5 commented that Kt/Vurea is the “most precise and tested measure of the dialyzer effect on patient survival.” In peritoneal dialysis CANUSA6 found that maintaining Kt/Vurea >2.0 was associated with a relative reduction in mortality, whereas the ADEMEX7 study found no difference in survival between the intervention (Kt/Vurea 2.27) and control (Kt/Vurea 1.8) groups.