We present a framework system dynamics (simulation) model that evaluates the effect of dialysis policies on session performance, quantifying, optimizing dialysis efficiency and monitoring dialysis performance online. The model focuses on analyzing and highlights factors which may alter the delivered dose and may lead to session degradation such as reduction in treatment time, ineffective urea clearance due to access recirculation, inadequate blood flow to the dialyzer, dialyzer clotting, low blood pump and dialysate flow, or underestimates of flow due to calibration errors and blood pump tubing collapse that related to hemodialysis machine maintenance. Thus our second goal is to increase the overall equipment effectiveness which is extremely important in evaluation of adequacy of hemodialysis. Routine preventive and annual maintenance is vital to provide a safe and adequate dialysis and must be conducted with careful attention and in a timely fashion. Five blood samples were drawn from 134 dialysis patient; arterial sample at the inlet of the dialyzer, venous sample at the outlet of the dialyzer, peripheral sample, pre blood urea sample and post blood urea sample. The post blood urea sample was drawn at different dialysis times to validate the results of our dynamical model with the measured results.