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Bed-side formulae established from urea kinetic modelling offers a simple and convenient tool to determine the protein catabolic rate (PCR) and its equivalent the dietary protein intake (DPI), in hemodialysis patients, two major parameters used for assessing the dialysis dose adequacy and its protein nutritional consequences. Simplified urea kinetic analysis, must be part of the permanent quality control of the hemodialysis patient. These formulae contribute to judge more objectively the efficacy of renal replacement therapy program delivered to hemodialysis patients. Indeed, these formulae may not substitute to the clinical judgment of physician and may not replace conventional and major dialysis adequacy indicators (blood pressure control, extracellular and blood pressure control, bone and mineral metabolism control, anemia correction) or nutritional status (anthropometric data, somatic proteins, subjective global assessment...) By providing a way of assessing "dose of dialysis delivered" and "dietary protein intake", bed-side formulae derived from urea kinetic modelling offer a convenient and cheap means of quantifying dialysis adequacy. These formulae bring to the Physician a necessary although not sufficient complementary tool for assessing dialysis adequacy in hemodialysis patient.

Residual renal function (RRF) contributes to the achievement of treatment adequacy in CKD-5 patients. It may facilitate patients' acceptance of renal replacement therapy (RRT) in minimizing dietary and fluid restriction. It has been confirmed to improve dialysis patient outcomes. Attempts to preserve RKF in incident CKD-5 patients are still subject to controversies. In this review we analyze the role of RRT in dialysis patient. What are the positive and the beneficial effects of maintaining RRF? What are the negative and the risks of maintaining a RRF? At what expense the maintenance of RRF is achieved? Preservation of RRF is undoubtedly an interesting means to enhance the efficacy of renal replacement therapy and reduce dietary fluid restriction. However, maintainance of RRF should not be considered as a goal of dialysis adequacy in dialysis patients but rather a means of optimizing RRT. Further, preservation of RRF should be considered as a permanent trade-off between patient comfort and chronic fluid volume overload with its deleterious effects.

Correcting the renal anemia in dialysis patient require the optimal management of the erythropoietic stimulating agents (ESA) available on the market. In other words, that means that the prescription of these agents should be performed according to the specific pharmacokinetic and pharmacodynamic profiles of these agents. Two major classes of ESA are presently available for clinicians: one being considered as short acting substances (epoetine alfa and Epoetine Beta); the other one being considered as long acting substances (darbepoetin alfa). Several other agents are being currently evaluated or waiting for approval. For the short acting ESA, subcutaneous administration has been proved able to reduce weekly needs by 20 to 30% for the same efficacy, while the optimal frequency dosing being once and twice per week. For long acting ESA, the beneficial effect of the subcutaneous administration tend to disappear in hemodialysis patient, while the optimal frequency dosing being once a week to once every two week. These treatment schedules of prescription must be adapted according to the dialysis modality (hemodialysis, peritoneal dialysis) and the basal needs for ESA. The efficiency of ESA is also conditioned by the dialysis quality and efficiency, the iron repletion state, the blood losses and the presence of resistance factors. The optimal management of anemia in dialysis patient relies on an optimized dosing of ESA, a reduction of blood losses and a suppression of resistance factors to ESA action.