title: The risks of high ultrafiltration rate in chronic hemodialysis: implications for patient care.
abstract: As dialytic practice has evolved, hemodialysis (HD) adequacy has come to be defined in terms of small molecule clearance. A growing body of evidence suggests that fluid dynamics, specifically ultrafiltration rate (UFR), bear clinical and physiological significance and should perhaps play a more central role in titrating HD therapy. Three recent studies have shown an independent association between higher UFR and mortality. Further work is needed to determine whether this relationship represents a direct toxic effect of rapid fluid perturbations or whether this association is a consequence of confounding on the basis of large interdialytic weight gain, as each would prompt a different therapeutic response. This mounting evidence builds the case that fluid management should play a more central role in the dialytic prescription and that more individualized approaches to fluid management should be encouraged.
authors.affiliation: Renal Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Flythe
authors.forename: Steven M
authors.initials: SM
authors.lastname: Brunelli
mesh_terms: D002318:Cardiovascular Diseases / Q000401:mortality / Q000503:physiopathology; D017583:Hemodiafiltration / Q000009:adverse effects* / Q000379:methods; D015312:Hemodialysis Solutions / Q000008:administration & dosage; D006801:Humans; D007022:Hypotension / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000503:physiopathology; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D014508:Urea / Q000378:metabolism
chemical_list: D015312:Hemodialysis Solutions; D014508:Urea