The role of urea kinetic modeling in assessing the adequacy of dialysis.

The adequacy of dialysis based on urea kinetic modeling has more than 20 years of history. Its methodological approach has demonstrated a strong capacity to improve the outcomes of the dialysis therapy. However, recent results of clinical interventional studies and necessary advances in new models of dialysis schemes, particularly daily and nocturnal hemodialysis, have led to the question if whether that methodology is suitable to address current challenges. This work tries to reach an answer to that question. The major conclusion is that urea kinetic modeling provides an extraordinary starting point to both keeping the clinical support to physicians and building new pharmacokinetic and physiological models that throw light on the understanding of the basic mechanisms that underlie the chronic renal disease, in a synergetic manner. Despite this promising expectation, misuse and improper extensions of urea kinetic modeling may jeopardize its credibility to nephrologists. Our concern about this issue emerges mainly from the analysis of recent attempts to extend this methodology to more frequent renal replacement therapies.