Dear HDC members and friends
At the Annual Dialysis Conference in Seattle last week, I presented a proposal I have been thinking about for some time … I have called it the ‘Good Dialysis Index’ - or GDI.
In retrospect, perhaps the ‘G’ should have been for Geelong and it should rightly be renamed the ‘Geelong Dialysis Index’.
I’ll let that one hang …
The full slide presentation given at the ADC cannot be reproduced here, though it began with the reasons why I distrust and dislike Kt/V as the primary assessment basis for dialysis ‘adequacy’ … by the way, adequacy is also a word I abhor.
From this dislike and distrust has grown a more simplistic and … yes … a more naive way of assessing the ‘goodness’ (or otherwise) of dialysis at the clinic visit - the GDI
Most importantly, the method I proposed - ‘The Good Dialysis Index’ - attempts to be more patient focused than Kt/V. Kt/V converts you, the patient, into a mathematical model … and a bad mathematical model at that.
Personally, I do not see dialysis patients as merely a complex and inaccurate jumble of bad mathematics. That approach, to me, does not do you justice, as a human being or as an individual. You deserve better.
I do not suggest that the GDI is the ‘be-all’ and ‘end-all’. The GDI is but a step in what I hope is the right direction … at least I think it is.
It has not been tested or validated. It is just a concoction, out of my personal clinical experience, of what I think matters. The questions I have included are, to my thinking, the chief things that matter - both to my patients and to me as their renal physician - when deciding if the dialysis given and received is achieving worthwhile goals. These goal are in four major target areas … patient goals, process goals, biochemical goals and outcome goals.
The sheet is designed to form part of the patient record. It can be completed in ~2-3 minutes and can be serially rated to determine progress. There is a column in which targets to overcome any ‘scoring deficits’ can be noted … focusing attention at the next clinic visit to see if by addressing the deficit, improvement has resulted.
I hope the GDI will ultimately be tested in large patient groups to assess its worth. Negotiations are underway to try to achieve this.
Until then, it remains just one far-distant renal physicians’ dreams of a better assessment tool.
Some patients (Bill Peckham, I will use your term, ‘dialyzors’) who were at the ADC have been ‘hot to trot’ to use it. I am not against this as long as it is used with the clear understanding of both the user and his/her renal physician that it has not been validated and is only ‘experimental’.
Those interested in the GDI - and/or any potential users of it - will find it at my website: http://www.nocturnaldialysis.org
Please visit http://www.nocturnaldialysis.org and carefully read and understand the introduction section at the website. This is important as it couches the intent of the GDI in the appropriate terms.
A printable version of the GDI is available for you at the website.