Assuring that ESRD patients receive the appropriate amount of renal replacement therapy at a rate that allows them to feel well and prevent adverse reactions is the ultimate goal for nephrologists. As defined by the National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (KDOQI), Clinical Practice Guideline for Hemodialysis Adequacy, the upper limit a patient should dialyze is 13 millimeters per hour per kilogram of body weight. Patients who dialyze at increased ultrafiltration rates are at greater risk for a cardiovascular event [1]. There are documented clinical benefits for patients who have longer and slower dialysis treatment [2]. Many clinics now offer nocturnal hemodialysis options to their patients so they can dialyze longer and slower while sleeping [3]. Facilities that do not offer a nocturnal program may want to consider increasing scheduled treatment times to ensure that patients are meeting their 1.2 Kt/V clearance goals and  maintaining an ultrafiltration rate of 13ml/hr/kg or slower.

REMINDER: Ultrafiltration rate reporting is a new requirement for the 2018 CMS Quality Incentive Program.

To read more, please click on the links below:

• KDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 Update
• ESRD QIP Summary: Payment Years 2016-2020

[1] https://www.ajkd.org/article/S0272-6386(15)01019-7/fulltext
[2] Chazot, C. MD, Guillaume, J. MD (2009). “The Advantages and Challenges of Increasing the Duration and Frequency of Maintenance Dialysis Sessions.” Nature Clinical Practice Nephrology
[3] Glickman, J. (2012, April 27). Stunning Consequences of Thrice-Weekly In-center Dialysis