Table 1.

What ways do we have to improve the dialysis process and how can we assess whether optimum dialysis has been achieved?

Optimum dialysis	How can this be assessed?
Well-functioning, long-lasting access with no complications	Compliance with ‘fistula first’ policy Access infection and access failure
Maintaining RKF	Urine output and use of diuretics
Target weight maintained, with normal BP without antihypertensives and no LVH	BP SDS, ECHO and number of antihypertensive medications
No discomfort during dialysis or intradialytic hypotension	Percentage with pain interfering with PD. Intradialytic weight gains and UF rates < 13 ml/kg/h
No anaemia, acidosis, or potassium, calcium, phosphate or PTH disturbance	Audit of haematological and biochemical control
Good nutrition and growth	Urea, albumin, Ht SDS, Wt SDS, head circumference SDS and pubertal development
No hospitalisations for complications	Hospitalisation rates
Psychosocial care provided and educational input	Access to social workers, psychologists and play therapists. Assessment of HRQoL-targeted educational needs and good school attendance

RFK residual kidney function, LVH left ventricular hypertrophy, PTH parathyroid hormone, BP blood pressure, SDS standard deviation score, PD peritonal dialysis, UF ultrafiltration