What is UF volume in dialysis?
This difference (in kilograms) equals the volume (in litres) that must be removed during the dialysis run by the process called ultrafiltration. The amount to be removed [gain 2 kg = remove 2 litres; gain 3 kg = remove 3 litres; ‘gain’ 4 kg = remove 4 litres … etc.] is the UF volume.
What is the target UF for peritoneal dialysis in anuric patients?
The European Best Practice Guideline Working Group on Peritoneal Dialysis set an arbitrary target that the minimum net UF in anuric PD patients should be 1 L/day [ 9 ]. However, the International Society for Peritoneal Dialysis believes that no numerical target for UF can be formulated using the present data [ 10 ].
What is the UF rate?
The UF rate is a speed, not a volume, and refers to the volume of water that must be removed in any given time!
Do maximum UF rates affect Intradialytic hypotension in in-center hemodialysis patients?
The effects of a weight-based UF rate limit on intradialytic hypotension and the potential for unwanted fluid weight gain and hospitalizations for volume overload are unknown. Methods: This retrospective cohort study examined 123 in-center hemodialysis patients at one facility who transitioned to 13 mL/kg/h maximum UF rates.
What is a safe UF rate in dialysis?
Currently, the Centers for Medicare & Medicaid Services (CMS) is considering an UF rate threshold of 13 mL/h/kg as a quality measure to assess dialysis facility fluid management, and such a threshold has been incorporated into the CMS 2016 End Stage Renal Disease Core Survey.
What is a safe ultrafiltration rate?
The key is to maintain a UFR <13ml/kg/hr to provide a safe ultrafiltration rate during treatment. Adding Prime and Rinse back after the fact will then increase your UFR to greater than 13mg/kg/hr. Your initial calculation is what will allow you to provide a safe treatment for the patient.
What is low UF in dialysis?
UFF, which can be defined as ultrafiltration (UF) of less than 400 mL after a 4-hour dwell duration with a 4.25% dextrose-based peritoneal dialysis fluid (PDF), is a clinical condition that has an increasing incidence with chronic PD duration.
How do you calculate ultrafiltration rate?
For both measures, the UF rate is calculated as UF rate (milliliters per hour per kilogram) = (predialysis weight − postdialysis weight [milliliters])/delivered TT (hours)/postdialysis weight (kilograms).
What is ultrafiltration a level?
Ultrafiltration is the first of three processes by which metabolic wastes are separated from the blood and urine is formed. It is the non-specific filtration of the blood under high pressure and occurs in the Bowman's capsule of the nephron.
What is UF failure?
Ultrafiltration (UF) failure is a common and important complication of peritoneal dialysis (PD), especially in long-term patients without residual urine production, because it often causes overhydration, which is an important cause of death in this population.
What causes negative UF?
Ultrafiltration failure means there is not enough fluid crossing the peritoneal membrane. Some things that can cause ultrafiltration to fail include uremia (high blood urea nitrogen), peritonitis (infection of the peritoneal membrane), and high dextrose PD solution (especially 4.25%).
How much fluid is removed in dialysis?
3% or less is recommended. It has been shown that the maximum amount of fluid removal during dialysis should be less than 13 cc/kg/hr to avoid risk, but that even at 10cc/kg/hr heart failure symptoms start to develop. Removing more than this is associated with increased mortality.
What is a normal UF in peritoneal dialysis?
Ultrafiltration in Peritoneal Dialysis PD solutions are available with 3 different amounts of dextrose: 1.5%, 2.5%, and 4.25%. Your PD clinician may tell you to increase the dialysate dextrose if their body weight goes above your target weight.
What is ultrafiltration rate in CRRT?
CRRT is usually initiated with a blood flow rate of 100mls/mt and gradually increased up to 200mls/mt. In CVVH, the ultrafiltrate volume is usually set around 1 to 3 litres/hr. Ronco et al showed in a randomised controlled trial that ultrafiltrate volumes of 35mls/kg/hr are superior to 20 or 45mls/kg/hr.
What is a good dialysis clearance?
If a patient's blood flow rate is good, further improvements in clearance can be obtained by using a big dialyzer or, in some cases, by increasing the flow rate for dialysis solution from the usual 500 mL/min to 600 or 800 mL/min. A good flow rate for adult patients is 350 mL/min and higher.
What is the difference between predialysis weight and post dialysis weight?
Most commonly, the predialysis weight is greater than the target weight. This difference (in kilograms) equals the volume (in litres) that must be removed during the dialysis run by the process called ultrafiltration.
How many litres of water to remove in 2 hours?
This means that: If there are 2 litres of water to remove (UF volume) and the dialysis run is 2 hours, the speed of removal—UF rate—will be 1 litre per hour. If there are 4 litres of water to remove (UF volume) and the dialysis run is 2 hours, the speed of removal (UF rate) will be 2 litres per hour. The UF rate is governed by two factors:
What is UF volume?
The UF volume is the amount of water that must be removed in a single treatment to return a patient to his or her target (or base) weight. The ultrafiltration volume is commonly expressed in terms of weight (where 1 litre = 1 kilogram).
What is the main thing that dialysis removes?
Dialysis removes two main things: Solutes – dissolved electrolytes (salts) and molecules of waste (toxins) made by the body’s daily functioning. Fluid (water). Convective positive or negative pressures that are applied to either side of the dialysis membrane largely determine the amount of water that is removed.
How many ml in 3 hours of dialysis?
A 3-hour dialysis would mean removing 5 litres (= 5000 mL) in 3 hours = 1,666 ml/hour = 1666 ÷ 100 kg or 16.6 mL/Kg/hr. That would do irreparable damage to the heart!
What happens if water is removed too fast?
To add one piece of complexity to this simple distinction, strong data has shown that if water is removed too fast and the circulating blood volume is contacted too quickly, organ perfusion pressures drop. In turn, this risks organ ischaemia and compromises organ oxygenation.
Is dry weight a goal?
Unfortunately, the exact measurement of dry weight remains a holy grail. Although there are all sorts of methods to try and determine it, dry weight is a notional goal rather than an actual, definable value.
Abstract
Higher ultrafiltration (UF) rates and extracellular hypo- and hypervolemia are associated with adverse outcomes among maintenance hemodialysis patients. The Centers for Medicare and Medicaid Services recently considered UF rate and target weight achievement measures for ESRD Quality Incentive Program inclusion.
Background
Adequate fluid management is increasingly accepted as an important component of hemodialysis treatment adequacy. Existing data suggest that rapid fluid removal, extracellular volume expansion and large interdialytic weight gain (IDWG) are risk factors for morbidity and mortality among maintenance hemodialysis patients [ 1, 2, 3, 4, 5, 6 ].
Methods
We evaluated the Kidney Care Quality Alliance (KCQA)-proposed post-dialysis weight above or below target weight measure (Measure 2702) submitted to the May 2015 NQF. The measure was submitted as a companion measure to the KCQA-proposed UF rate measure (Measure 2701) [ 7 ].
Results
Target weight measure analyses considered 152,196 unique patients from 1874 facilities (Fig. 1 ). The mean age was 61 years, 36.4% were black, 17.3% were Hispanic, 24.9% had heart failure and 70.3% had prescribed TTs <240 min in the first reporting month of 2012. The cohort was similar to the broader U.S.
Discussion
In this study we examined target weight achievement patterns, the proposed but unendorsed target weight clinical performance measure and estimated the theoretical cumulative fluid-related weight gains that could result from UF rate threshold implementation.
Conclusions
In conclusion, our data highlight the importance of reconsidering the target weight measure or developing a new measure that could serve as a counter-balance to the UF rate clinical performance measure.
Acknowledgments
The authors thank DaVita Clinical Research for providing data for this study. DaVita Clinical Research had no role in the design or implementation of this study or the decision to publish. The authors thank Alan Brookhart for data access and Diane Reams for her data and contract management assistance.
What is maintenance dialysis?
Background. Maintenance dialysis therapy is the only way to remove excess fluid in patients with anuric end-stage renal disease. The optimal ultrafiltration (UF) volume in patients on peritoneal dialysis (PD) remains controversial.
Is peritoneal dialysis a renal replacement?
Over the past four decades, peritoneal dialysis (PD) has been an important form of renal replacement therapy for patients with end-stage renal disease (ESRD). Previous studies have reported similar patient survival rates for PD and haemodialysis when appropriate adjustments are made for differences in case mix [ 1 ]. However, a number of studies have shown that fluid overload is prevalent in PD patients, especially in patients who have lost their residual renal function (RRF) [ 2–4 ]. Inadequate fluid removal in this population contributes to hypertension and is associated with an increased risk of cardiovascular disease [ 5 ], hypoalbuminaemia [ 6] and systemic inflammation [ 7 ]. Indeed, reanalysis of the large CANUSA study has shown that the decrease in RRF, rather than peritoneal creatinine clearance, best predicts both mortality and morbidity in PD patients [ 8 ]. According to this analysis, every increase of 250 ml in urine output leads to a 36% decrease in mortality risk [ 8 ], again suggesting the important role of fluid status in predicting clinical outcome.
