@article{2b7d0b97cf8c4ac5b32f44bef2b6aa9a,
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 ≥ 13 mL/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{\textquoteright} 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.",
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",
author = "Holly Kramer and Jerry Yee and Weiner, {Daniel E.} and Vinod Bansal and Choi, {Michael J.} and Laura Brereton and Berns, {Jeffrey S.} and Milagros Samaniego-Picota and Paul Scheel and Michael Rocco",
note = "Funding Information: Support: No institutional funding has been provided for this work. Funding Information: Financial Disclosure: Dr Weiner was a member of the work group that developed the KCQA ultrafiltration measure and of the guideline work group for the 2015 updated NKF-KDOQI clinical practice guideline for hemodialysis adequacy. He receives research funding from Dialysis Clinic Inc, Boston, where he serves as Medical Director. Dr Berns has provided consultancy to Bayer and Amgen on the subject of anemia. Dr Choi acknowledges consultancy to the Glaxo Smith Kline-Data Monitoring Safety Board and Genentech Advisory Board. Dr Bansal is Medical Director at Loyola University Outpatient Dialysis Center. Dr Yee is Chief Medical Director at Greenfield Health Systems, Bingham Farms, MI. Dr Samaniego acknowledges research and speakers bureau grants from Alexion Pharmaceuticals and consultancy for Sanofi and Thermo-Fisher Corporation. The other authors declare that they have no relevant financial interests. Publisher Copyright: {\textcopyright} 2016 National Kidney Foundation, Inc. Copyright: Copyright 2018 Elsevier B.V., All rights reserved.",
year = "2016",
month = oct,
day = "1",
doi = "10.1053/j.ajkd.2016.06.010",
language = "English (US)",
volume = "68",
pages = "522--532",
journal = "American Journal of Kidney Diseases",
issn = "0272-6386",
publisher = "W.B. Saunders Ltd",
number = "4",
}