The risks of high ultrafiltration rate in chronic hemodialysis: implications for patient care

Semin Dial. May-Jun 2011;24(3):259-65. doi: 10.1111/j.1525-139X.2011.00854.x. Epub 2011 Apr 11.


As dialytic practice has evolved, hemodialysis (HD) adequacy has come to be defined in terms of small molecule clearance. A growing body of evidence suggests that fluid dynamics, specifically ultrafiltration rate (UFR), bear clinical and physiological significance and should perhaps play a more central role in titrating HD therapy. Three recent studies have shown an independent association between higher UFR and mortality. Further work is needed to determine whether this relationship represents a direct toxic effect of rapid fluid perturbations or whether this association is a consequence of confounding on the basis of large interdialytic weight gain, as each would prompt a different therapeutic response. This mounting evidence builds the case that fluid management should play a more central role in the dialytic prescription and that more individualized approaches to fluid management should be encouraged.

Publication types

  • Editorial

MeSH terms

  • Cardiovascular Diseases / mortality
  • Cardiovascular Diseases / physiopathology
  • Hemodiafiltration / adverse effects*
  • Hemodiafiltration / methods
  • Hemodialysis Solutions / administration & dosage
  • Humans
  • Hypotension / physiopathology
  • Kidney Failure, Chronic / mortality
  • Kidney Failure, Chronic / physiopathology
  • Renal Dialysis / adverse effects*
  • Renal Dialysis / methods
  • Renal Dialysis / mortality
  • Urea / metabolism


  • Hemodialysis Solutions
  • Urea