One measure of dialysis adequacy is the standard Kt/V, which can be used for dialysis regimens of varying treatment duration and frequencies. The standard Kt/V

is a calculation based on the midweek pre-dialysis urea level, with the assumption that the mean pre-dialysis urea portends equivalent FDA-approved Drug Library uraemic toxicity to steady-state urea concentrations of continuous therapies (such as continuous ambulatory peritoneal dialysis). When comparing the standard Kt/V across HD schedules, in conventional HD a standard Kt/V of 2.0 corresponds to a single-pool Kt/V of 1.2 per treatment (minimally adequate dialysis). In NHD, daily dialysis is associated with a lower pre-dialysis urea level, and therefore a standard Kt/V of 4.0–5.0 is achieved (as these JQ1 price sessions are both longer and more frequent) with a single-pool Kt/V of about 1.8–2.5 per treatment.41 This is achieved even when using lower blood and dialysate flows compared with conventional HD. In SDHD, targeting a standard Kt/V of 2.0, the corresponding single-pool Kt/V typically is 0.53–0.56 per treatment (approximately half that achieved in a single conventional HD treatment). The other more commonly used measure of conventional HD adequacy in Australia is the urea reduction ratio (URR) or percentage of urea reduction (PUR), calculated using the pre- and post-dialysis

urea levels. For NHD and SDHD, it is difficult to determine the relevance of these measures as they have been historically used to assess adequacy of conventional HD; and the lower pre- and post-dialysis urea concentrations especially in NHD often make Palmatine these tools unreliable for this regimen. Daily HD allows for increased clearance of middle-molecules

because of less rebound; and NHD increases middle-molecule removal as a result of higher frequency and duration of HD. The relative increase in total solute removal with NHD is greatest for middle-molecules such as phosphate and β2-microglobulin, compared with small solutes such as urea and creatinine; and greater convective removal is also seen as a result of higher weekly ultrafiltration.42–45 On conversion from conventional HD to NHD, one study reported serum β2-microglobulin levels decreased from 27.2 to 13.7 mg/dL after 9 months with an increase in β2-microglobulin mass removal from 127 to 585 mg.46 Removal of protein-bound molecules, such as indole-3-acetic acid indoxyl sulfate and p-cresyl sulfate, has also been reported to be greater with SDHD and NHD compared with conventional HD.47,48 Most conventional home HD patients have a partner to assist with set-up, needling and fluid administration; and this is often necessary especially if the patient is prone to hypotension. However, this may result in additional stress to family dynamics. In contrast, NHD patients at home are much less likely to have hypotension and many do not have a partner.