2006 Updates Clinical Practice Guidelines and Recommendations

y KDOQI (spKt/V � 1.3 per dialysis), but the rationale for increasing the target was not
clearly delineated. The group recommended using the mean of creatinine and urea clearance
as a measure of RKF and discouraged twice-weekly dialysis.
In the United States, we have come a long way, from marveling about how HD can
snatch patients from the jaws of death and keep them alive indefinitely to coping with
0.1% of the population depending on HD for life support. Nephrologists have learned
that, although numbering more than 300,000, these patients represent a small segment
of approximately 20 million people in the United States with kidney disease who have
survived tremendous risks for CVD and other morbid diseases to develop CKD stage 5.
They often arrive in the dialysis clinic with a legacy of diabetes, CVD, and inflammatory
diseases that continue to progress. The challenge for today’s health care workers and the
dialysis industry is to provide an opportunity for these patients to live long and comfortably
with freedom to pursue their dreams, even if for only a relatively short length of time
in those at high risk. We need to be all things for these patients, but first and foremost,
we must deliver the best dialysis therapy we can with available technology. These new
KDOQI HD CPGs, CPRs, and Research Recommendations are designed to provide a
clearer pathway and help everyone move in that direction.
KDOQI National Kidney Foundation 15