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

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• 作者：Holly Kramer ; MD ; MPH¹ ; ² ; ^{hkramer@luc.edu" class="auth_mail" title="E-mail the corresponding author} ; Jerry Yee ; MD³ ; Daniel E. Weiner ; MD ; MS⁴ ; Vinod Bansal ; MD¹ ; Michael J. Choi ; MD⁵ ; Laura Brereton ; MSc⁶ ; Jeffrey S. Berns ; MD⁷ ; Milagros Samaniego-Picota ; MD⁸ ; Paul Scheel Jr. ; MD ; MBA⁵ ; Michael Rocco ; MD⁹
• 关键词：Hemodialysis (HD) ; dialysis ; ultrafiltration rate (UFR) ; quality of care ; performance measure ; interdialytic weight gain (IDW) ; sodium ; volume management ; dialysis dose ; treatment time ; fluid removal ; end-stage renal disease (ESRD) ; NKF-KDOQI ; controversies
• 刊名：American Journal of Kidney Diseases
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：68
• 期：4
• 页码：522-532
• 全文大小：380 K

文摘

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.