title: Ultrafiltration Rate Thresholds in Maintenance Hemodialysis: An NKF-KDOQI Controversies Report.
abstract: High hemodialysis ultrafiltration rate (UFR) is increasingly recognized as an important and modifiable risk factor for mortality among patients receiving maintenance hemodialysis. Recently, the Kidney Care Quality Alliance (KCQA) developed a UFR measure to assess dialysis unit care quality. The UFR measure was defined as UFR≥13mL/kg/h for patients with dialysis session length less than 240 minutes and was endorsed by the National Quality Forum as a quality measure in December 2015. Despite this, implementation of a UFR threshold remains controversial. In this NKF-KDOQI (National Kidney Foundation-Kidney Disease Outcomes Quality Initiative) Controversies Report, we discuss the concept of the UFR, which is governed by patients' interdialytic weight gain, body weight, and dialysis treatment time. We also examine the potential benefits and pitfalls of adopting a UFR threshold as a clinical performance measure and outline several aspects of UFR thresholds that require further research.
authors.affiliation: Division of Nephrology, Department of Medicine, Loyola University Chicago, Maywood, IL; Department of Public Health Sciences, Loyola University Chicago, Maywood, IL. Electronic address: hkramer@luc.edu.
authors.forename: Holly
authors.initials: H
authors.lastname: Kramer
authors.affiliation: Division of Nephrology, Department of Medicine, Henry Ford Medical Center, Detroit, MI.
authors.forename: Jerry
authors.initials: J
authors.lastname: Yee
authors.affiliation: Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Weiner
authors.affiliation: Division of Nephrology, Department of Medicine, Loyola University Chicago, Maywood, IL.
authors.forename: Vinod
authors.initials: V
authors.lastname: Bansal
authors.affiliation: Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Choi
authors.affiliation: National Kidney Foundation, New York, NY.
authors.forename: Laura
authors.initials: L
authors.lastname: Brereton
authors.affiliation: Renal, Electrolyte, and Hypertension Division, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Berns
authors.affiliation: Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, MI.
authors.forename: Milagros
authors.initials: M
authors.lastname: Samaniego-Picota
authors.affiliation: Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Paul
authors.initials: P
authors.lastname: Scheel
authors.affiliation: Division of Nephrology, Department of Medicine, Wake Forest University, Winston-Salem, NC.
authors.forename: Michael
authors.initials: M
authors.lastname: Rocco
mesh_terms: D006333:Heart Failure / Q000209:etiology; D006801:Humans; D006973:Hypertension / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000628:therapy*; D017410:Practice Guidelines as Topic; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods; D014462:Ultrafiltration / Q000706:statistics & numerical data
keywords: Hemodialysis (HD); NKF-KDOQI; controversies; dialysis; dialysis dose; end-stage renal disease (ESRD); fluid removal; interdialytic weight gain (IDW); performance measure; quality of care; sodium; treatment time; ultrafiltration rate (UFR); volume management