What dose of dialysis is considered adequate for in center hemodialysis?
For patients receiving hemodialysis three times per week, the 2016 NKF-KDOQI Hemodialysis Adequacy guidelines recommend “a target single pool Kt/V (spKt/V) of 1.4 per hemodialysis session for patients treated thrice weekly, with a minimum delivered spKt/V of 1.2 (Grade 1B) and a minimum treatment time of 3 hours if residual kidney function is less than 2 mL/min (Grade 1D).” These guidelines also note that “for hemodialysis schedules other than thrice weekly, we suggest a target standard Kt/V of 2.3 per week with a minimum delivered dose of 2.1 using a method of calculation that includes the contributions of ultrafiltration and residual kidney function (Not Graded).” A higher dose of dialysis, achieved by either additional hemodialysis sessions or longer hemodialysis treatment times, should be considered for patients with large weight gains, high ultrafiltration rates, poorly controlled blood pressure, difficulty achieving dry weight, or poor metabolic control (such as hyperphosphatemia, metabolic acidosis, and/or hyperkalemia (Not Graded).
