Real-time dialysis dose monitoring technology will significantly improve patient outcomes and reduce hospital admissions 

The Challenge: Poor clearance rates and vascular access issues in dialysis 

Around 3.25 million people in the UK live with later stage chronic kidney disease when symptoms become increasingly difficult to manage.¹⁶

Right now, over 70,000 people are being treated for kidney failure (where kidney function is less than 15%) with more than 31,000 patients on dialysis.¹⁶ For these patients, haemodialysis is literally a lifeline, replacing lost kidney function by filtering waste and excess fluid from the blood. 

However, despite advancements in treatment, many dialysis patients continue to suffer from poor clearance levels (the process of removing waste products, such as urea, from the blood), vascular access complications and high hospital admission rates. 

The UK Renal Registry’s 2024 Annual Report reveals almost a fifth - 18.6% - of dialysis patients fails to receive adequate dialysis, meaning their bodies are not effectively removing toxins.³  

That’s around 4,750 people who are receiving suboptimal treatment. This is not just a number, it represents an unnecessary toll of lives blighted. The failure to meet minimum clearance targets severely impacts the quality of daily life – from much poorer physical and mental health to an inability to go about the activities of daily life or remain in employment.  It also has serious potential consequences leading to increased risks of heart disease, high blood pressure, bone disease and anaemia.

These concerning figures raise critical questions about the awareness and implications of underdosing in dialysis for patients, healthcare professionals and the NHS.

Tackling poor clearance rates will not only have significant health benefits for renal patients but also deliver considerable cost, efficiency and occupational benefits to an over-stretched NHS that, in 2023 alone, spent £1.05 billion on dialysis.¹⁷

So, how can dialysis treatment be improved to deliver better clearance rates, reduce hospital admissions and enhance patient outcomes?

The Solution: Real-time dialysis dose monitoring with B. Braun’s Dialog iQ with Adimea integration

Poor clearance rates are caused by a range of factors including inadequate dialysis prescription, patient non-compliance and - critically - vascular access issues.

Traditionally, dialysis adequacy is monitored through monthly blood tests, which measure urea reduction ratio (URR) or Kt/V (a measure of dialysis dose). While effective in identifying treatment issues, this approach has major limitations: 

• Delays in intervention: problems may go unnoticed for weeks before test results reveal inadequate clearance. 

• Reactive rather than proactive care: adjustments to dialysis settings often happen after a patient has already suffered from poor treatment. 

• Missed opportunities to optimise treatment: without continuous monitoring, nurses and clinicians lack real-time feedback to adjust dialysis settings during a dialysis session. 

To address these challenges, B. Braun has introduced the Adimea system, a real-time dialysis dose monitoring technology integrated into Dialog iQ haemodialysis machines.  

Distinct from typical clinical practice, Adimea continuously tracks dialysis effectiveness throughout the treatment session supporting immediate therapy adjustments to optimise patient care.

How Adimea Works 

Adimea (short for Accurate Dialysis Measurement) utilises spectroscopy to measure urea concentration in spent dialysate—the fluid carrying the toxins removed from the blood. This enables continuous calculation of Kt/V, providing real-time feedback on treatment effectiveness. 

If a patient’s clearance is falling short, Adimea triggers an alert, allowing nurses to adjust treatment parameters immediately rather than waiting for monthly blood results. This real-time feedback shifts dialysis care from being reactive to proactive, significantly improving patient outcomes and empowering nurses to make evidence-based decisions.⁴ 

Key Benefits of Adimea and Dialog iQ in Dialysis Care

Immediate Adjustments for Improved Dialysis Efficiency 

By eliminating guesswork, Adimea ensures that every dialysis session is as effective as possible, helping to reduce the likelihood of complications, hospitalisations and treatment inefficiencies. 

Adimea is integrated into every Dialog iQ machine and is now available to every customer and it is hoped that, as the NHS continues to seek cost-effective ways to improve patient care, Adimea’s real-time monitoring technology could become a new standard in dialysis treatment. 

Instead of waiting for problems to arise, we now have the ability to monitor, detect, and act in real time—transforming dialysis care for thousands of patients across the UK. This will reduce complications such as nausea, dizziness, arrhythmias, exhaustion, shortness of breath, cramping, confusion and weakness.

And that transformation will, in turn, significantly enhance the quality of life for dialysis patients – improving their ability to perform everyday tasks, to work and enjoy hobbies and relationships. 

Real-time problem detection and correction is empowering for nurses and improves job satisfaction. For nurses, this technology is also a powerful tool. Instead of waiting for monthly lab results, they can now track clearance throughout the dialysis session and adjust treatment as needed. This enhanced autonomy allows them to deliver more personalised, effective care, improving both patient outcomes and job satisfaction.

Early Detection of Vascular Access Issues 

One of the biggest contributors to poor clearance rates is vascular access dysfunction. Issues such as stenosis (narrowing of the blood vessel), clotting or recirculation problems can prevent efficient blood flow, reducing the effectiveness of dialysis. 

Haemodialysis patients are hospitalised nearly twice a year⁸ with 37% facing readmission within a month⁹, and nearly a third of those are due to vascular-access related complications^10,11.

Without real-time monitoring, adjusting dialysis treatment often involves a trial-and-error process. If a patient’s blood test shows inadequate clearance, dialysate flow may be adjusted, dialysis time increased or blood flow rate changed —but the impact of these adjustments won’t be known until the next monthly test. 

With Adimea’s real-time clearance monitoring, nurses and clinicians can spot early signs of vascular access failure before they lead to serious complications.  

The system’s continuous tracking of blood flow rates, ultrafiltration (UF) efficiency, and dialysate pressure, alongside the real-time clearance calculation, allows for early intervention—potentially avoiding hospital admissions and emergency fistula procedures. 

Whilst this is hugely positive for the patient, early detection can also translate into significant NHS cost savings, considering that vascular access procedures account for 25% of total dialysis care costs.¹⁸

Improved Patient Adherence and Engagement 

For patients, one of the biggest challenges of dialysis is staying motivated and engaged in their treatment. Studies suggest that up to 50% of haemodialysis patients struggle with adherence⁶, whether by cutting sessions short, missing treatments or failing to follow dietary restrictions. 

The challenge of treatment adherence is far more nuanced than simply following medical instructions. It’s a complex interplay of psychological, physical and practical factors that affect each patient differently.

Depression, which is notably common among dialysis patients, can significantly impact on an individual’s ability to maintain their treatment regimen. The physical demands of regular dialysis sessions, combined with time constraints and travel requirements, create substantial barriers to consistent treatment.

What makes Adimea so valuable is its ability to address multiple aspects of these challenges at the same time. 

With Dialog iQ and Adimea, patients no longer need to blindly trust in the process but can now see their treatment progress in real time, helping them understand the importance of completing full sessions. 

The immediate feedback helps alleviate anxiety about treatment effectiveness. The clear, visual progress indicators give patients a sense of control and accomplishment. Many patients who might have been tempted to leave early changed their minds after seeing their clearance curve in real time.¹  Perhaps, most importantly, it helps create a partnership between the patient and their care team. 

A Future of Smarter Dialysis Care 

B. Braun’s Dialog iQ with Adimea represents a major step forward delivering smarter, more efficient patient-centred dialysis care. 

With continuous clearance monitoring, early detection of vascular issues and immediate treatment adjustments Dialog iQ with Adimea offers a solution that could: 

• Improve patient outcomes and quality of life by ensuring optimal dialysis clearance

• Reduce hospital admissions by detecting vascular issues earlier

• Enhance patient engagement and adherence

• Cut NHS costs by preventing complications and unnecessary procedures

References

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3. UK Kidney Association (2024) UK Renal Registry 26th Annual Report. Available at: https://ukkidney.org/sites/renal.org/files/publication/file-attachments/UKKA%2026th%20Annual%20Report%202024-07-07.pdf (Accessed: 7 July 2024).
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