I. What is adequate dialysis? Adequate dialysis refers to the clinical requirement that the patient, with a certain amount of protein intake, seeks to apply the shortest time and the most effective method to remove uremic toxins, so that the blood uremic toxins are removed in the right amount and maintained at a certain level of value in the inter-dialysis period. Dry weight can be achieved by ultrafiltration dehydration. Patients are dialyzed smoothly without cardiovascular complications and water, electrolyte and acid-base imbalances. After dialysis, the patient feels comfortable and satisfied, so that the patient has a good quality of life and working ability, and becomes a “dialyzer” rather than a “dialysis patient”. Second, what is the appropriate dialysis treatment What kind of dialysis is the best? This is the patient’s most concerned about the problem, so to speak, in the dialysis patient can feel the most comfortable, and a long time to be able to enjoy a meaningful life, which can be said to be the best results of dialysis, which is the goal of dialysis treatment. So how many hours at a time? How many times a week is the most effective dialysis treatment? As we all know, our kidneys are working non-stop minute by minute during the whole life, no matter day or night, this is the normal state, so the artificial kidney is also the same if it doesn’t leave the body for 24 hours, it is the most appropriate. However, if this is the case, a person can not work at all, thus the question of how many times a week, a few hours at a time, what kind of arrangement is needed for a person whose kidneys are not functioning at all can not be generalized, but should take into account the person’s physique and the quantity and quality of the food he usually consumes, and here the term “dialysis volume” appears, what is the “dialysis volume”? What is “dialysis volume”? It is equal to dialyzer area clearance x time x number of times. The minimum dialysis volume for a person is about 10 square meters per hour, and it is very difficult to survive for a long time if this volume is not reached. Some people compare the life of dialyzers to crossing a bridge, if you pay attention to not fall down, you can walk the same distance as normal people, if the bridge is too narrow, then the chance of falling down will be very big; if you walk on a wide, flat bridge, you can not only be safe and secure, but also can enjoy the scenery on both sides of the bridge, so what is the width of the bridge? This is the “dialysis volume”. Most people, after receiving dialysis treatment for a period of time, the whole body condition can be improved, and then they ask for shorter dialysis time and fewer dialysis sessions, which is very tempting for you, but please calculate your “dialysis volume”, and won’t the reduction of them make your bridge become too narrow? One may ask if it is possible to achieve the same “dialysis volume”, is it not possible to dialyze once a week? As we have mentioned before, the kidney under normal condition is working non-stop every minute to maintain the constant state of the body, if dialysis is done once a week, the cells of the body will be subjected to rapid changes which are not tolerable, and it is very difficult for you to undergo dialysis for a long period of 20 hours at a time, so you must think that this is not feasible either. According to European data, patients on dialysis for less than 12 hours per week have a higher mortality rate than those on dialysis for more than 12 hours. The requirement for dialysis varies according to the amount of residual kidney function. If the urine volume is more than 800 ml/day, it generally indicates that the residual renal function is >8 ml/min, and the dialysis should be at least 10-12 hours per week; if the urine volume is less than 800 ml/day, the dialysis should be 12-15 hours per week, and the dialysis should be preferred 3 times per week than 2 times per week. The conventional dialysate flow rate has been fixed at 500 mL/min, but the blood flow rate is preferably 250-350 mL/min, and the number of dialyzer reuse should be less than 5 times. If you dialyze only once a week, the metabolic wastes of the remaining 6 days will build up severely, reproducing the symptoms of uremia and failing to achieve the goal of adequate treatment. If you have no residual renal function at all, longer dialysis or high blood flow dialysis is needed to achieve the adequacy of dialysis, 3 times per week, 4~5 hours each time is recommended. Younger people, without cardiovascular lesions, can shorten the dialysis time by using high flux dialyzer and increasing blood flow. However, the elderly have their unique characteristics, it is not suitable to use high-flow dialyzer, blood flow should not be higher than 150~200 ml/min, so it can only be carried out 3 times a week dialysis, barely reduce the dialysis time, metabolic waste retention, dialysis is not sufficient, so as to appear a variety of discomforts, low body resistance, quality of life declines, and the chance of infection, death is bound to increase. Therefore, in order to achieve the adequacy of dialysis, we should obey the doctor’s arrangement and should not blindly reduce the number of dialysis. How to assess the adequacy of dialysis? At present, there is no satisfactory objective index to show the adequacy of dialysis. In recent years, according to the urea kinetic model, the index of adequacy of dialysis has been proposed: overall urea clearance index (KT/V), mean time urea value (TACurea), proteolytic catabolism rate (PCR), and urea reduction rate (URR). Overall there are no standardized criteria for dialysis adequacy, and evaluating the adequacy of dialysis is a continuous process. Because a series of symptoms and characteristics of comorbidities can appear in both patients with adequate dialysis and patients with inadequate dialysis, only that the latter appear earlier and more frequently. How can dialysis patients survive for a long time? 1.Adequate dialysis is the key to long-term survival, and the dialysis program should be formulated reasonably. 2.Rational application of antihypertensive drugs. A hypertensive dialyzer cannot have a good quality of life, let alone long-term survival. 3.Good nutrition is very important. Protein intake should be 1,2~1,5 g/kg per day, and calorie supply should be sufficient (40 kcal/kg/day). 4, Strict control of water. For oliguria or anuria, it is necessary to limit the amount of water intake, and the weight gain between dialysis is less than 4%. 5, appropriate supplementation of water-soluble vitamins, such as vitamin B, folic acid, vitamin E and so on. 6.Appropriately increase the activities within the capacity, strive to resume work, and actively participate in various social activities. 7, prevention and treatment of anemia, renal bone disease, hyperlipidemia, cardiovascular disease and infection and other complications that affect the quality of life.