Ultrafiltration Rate Thresholds in Maintenance Hemodialysis: An NKF-KDOQI Controversies Report

Holly Kramer, Jerry Yee, Daniel E. Weiner, Vinod Bansal, Michael J. Choi, Laura Brereton, Jeffrey S. Berns, Milagros Samaniego-Picota, Paul Scheel, Michael Rocco

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


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’ 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.

Original languageEnglish
Pages (from-to)522-532
Number of pages11
JournalAmerican Journal of Kidney Diseases
Issue number4
StatePublished - Oct 1 2016


  • Hemodialysis (HD)
  • 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


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