Hemodialysis - Kt/V Urea

Guideline Organization

Recommendation (Evidence Level)

Evidence

Comments

CARI-Australia
2005

The minimum achieved spKt/V should be 1.2 (URR = 65%). To consistently achieve this in at least 80% of patients, it is recommended that the target spKt/V should be 1.4 (URR = 70%). (Levels III-IV)

Dialysis adequacy guidelines.
Dose of Haemodialysis

- Adequacy of dialysis should be assessed on all patients at least 3-monthly, as clinically-based assessment has proven unreliable. (Levels III-IV)
- Adequate dialysis should always include careful blood pressure control and
ECF volume management with regular re-evaluation of ideal dry weight, salt intake and a review of the ultrafiltration rate. (Levels III-IV)
- Adequacy of dialysis can be assessed in several ways. The most common
acceptable methods are: formal urea-kinetic Kt/V, URR, natural log Kt/V and the Daugirdas second generation formula. A renal unit should be consistent in the method it uses. (Opinion)

CSN-Canada
1999

1.2 Kt/V Min
65% URR Min

(Target Rationale)

Guideline 4.1 Dosage of hemodialysis delivered

Recommended dose based on 3 times a week delivery.
Suggested measurement interval is at least every 6-8 weeks. (Level III-IV)

EBPG-Europe 
2002

~1.4
(urea eKt/V >1.20)  (Target Rationale)

Guideline II.1.3 Page 18 of Section II
References can be found in EBPG for hemodialysis, section II:  dialysis adequacy, at the end of II.5:  dialysis schedules:  refs #45-122

Minimum dose based on thrice weekly schedule, but Twice-weekly schedules are not recommended.
Kt/V should be checked at least monthly.
Evidence Level B

KDOQI-US
2002

1.2 Kt/V Min (delivered)
65% URR Min  (Target Rationale)

Guideline 4 Minimum delivered dose of hemodialysis

Measurement of HD dose at least once per month.
Prescribed dose of HD should be Kt/V 1.3 or 70% URR, in order to reach the target of 1.2 in the large majority of patients.
Opinion

UK-Guidelines
2002

Every patient with end-stage chronic renal failure receiving thrice weekly HD should have consistently:

1. either urea reduction ratio (URR) > 65%
2. or equilibrated Kt/V of >1.2 (or sp Kt/V of > 1.3) calculated from pre- and post-dialysis urea values, duration of dialysis and weight loss during dialysis.

(Target Rationale)

Haemodialysis Guideline: Haemodialysis dose, frequency, and duration

To achieve a URR above 65% or eKt/V above 1.2 consistently in the vast majority of the haemodialysis population clinicians should aim for a minimum target URR of 70% or minimum eKt/V of 1.4 in individual patients. Aiming for these target doses also addresses the concerns raised by recent data which suggest that women and patients of low body weight may have improved survival rates if the URR is maintained above 70% or eKt/V is at least 1.4.