There's quite a nice blog post here on performance metrics... https://www.datadoghq.com/blog/vsphere-metrics/
In particular...
In order for a VMKernel to accurately discern how much memory is actively in use by VMs, it would need to monitor every memory page that has been read from or written to. This process, however, would require too much overhead. Instead, the VMKernel uses algorithmic learning to generate an estimate of each VM’s active memory usage. The VMKernel reports this estimate, measured in KBs, as the mem.active metric. Consumed memory, measured by the mem.consumed metric, represents the amount of an underlying host’s memory that’s allocated to a VM.
Active memory is a good real-time gauge of your VMs’ memory usage, and monitoring it alongside consumed memory can help you determine if virtual machines have sufficient memory allocated to them. If a VM’s active memory is consistently significantly below it’s consumed memory, it means it has more memory allocated to it than it needs and, as a consequence, the host has less memory available for other VMs than it could. To amend this, consider changing your VM’s configured size or memory reservation.
and...
At the VM level, the mem.usage metric measures what percentage of its configured memory a VM is actively using Ideally, a VM should not always be using all of its configured memory. If it is consistently using a large portion of its configured memory, the VM will be less resilient to any spikes in memory usage if its ESXi host cannot allocate additional memory. If this is the case, consider reconfiguring VM memory size, updating its memory allocation settings (shares, reservations, etc.), or migrating the VM to a cluster with more memory.
At the host level, memory usage represents the percentage of an ESXi host’s physical memory that is being consumed. If memory usage at the host level is consistently high, it may not be able to provision memory to the VMs that need it and it will need to run memory ballooning more often or may even begin to start swapping memory.