Scaled Ultrafiltration Rate in Hemodialysis—Time for a Change?

Risk-Based Thresholds for Hemodialysis Ultrafiltration Rates

“…Scaling for body weight adds an additional layer of complexity because a patient's nutritional intake can affect both their appropriate target body weight and their sodium and fluid intake, which primarily determines interdialytic weight gain. 6…”

“…Residual urine output (associated with lower interdialytic weight gain and lower mortality), nonadherence to salt and fluid restriction (associated with higher interdialytic weight gain and higher mortality), and poor nutritional intake (associated with lower interdialytic weight gain and higher mortality) all potentially influence the association between ultrafiltration rate and mortality. As previously noted by Hobby, 6 the largest studies assessing the association between ultrafiltration rates and mortality only assessed ultrafiltration rates scaled for body weight. Scaling for body weight adds an additional layer of complexity because a patient's nutritional intake can affect both their appropriate target body weight and their sodium and fluid intake, which primarily determines interdialytic weight gain.…”

“…Scaling for body weight adds an additional layer of complexity because a patient's nutritional intake can affect both their appropriate target body weight and their sodium and fluid intake, which primarily determines interdialytic weight gain. 6 A 2022 study of 2542 patients on maintenance hemodialysis thrice weekly was the first to examine the association between unscaled ultrafiltration rate and mortality. 7 It found that while there was higher risk of death with higher ultrafiltration rates, the magnitude of risk was greater in patients with a higher versus lower body mass.…”