Table 1.

Suggested clinical criteria for assessment and adjustment of ultrafiltration rate (UFR) in hemodialysis patients

	Remove more fluid or decrease target dry weight	Remove less fluid or increase target dry weight	Comments
Baseline systolic BP	High, e.g. >160 mmHg	Low, e.g. <120 mmHg	If sBP increases 1–2 hrs after HD initiation (intradialytic hypertension), may need more fluid removal
Intradialytic BP change	Not known	Not known	The difference between pre- and post-HD sBP should not be larger than 20–30 mmHg2
Cardiac symptoms	Pulmonary edema (see below)	Tachycardia, palpitation, chest pain	Stope UFR if chest pain is reported
Pulmonary Symptoms	Pulmonary congestion or SOB	-
CNS symptoms	-	Lightheadedness	Headache towards the end of HD may suggest need to lower UFR
Musculoskeletal Symptoms	If no cramps	If worsening cramps	Cramps may happen towards the end of HD
Perspiration		Sweating towards the end of HD session
Peripheral edema	Lower extremity or sacral edema	Not even trace edema at the start of dialysis
Inter-dialytic weight gain	High	Low	Generally, weight gain between 2 HD session should be less than <1.5 kg
Residual kidney function (RKF)	If minimal to no residual kidney function	If urine volume >500 cc/day or Kru>3 ml/min	Least UFR is recommended in patients with substantial RKF in order to prolong preservation of RKF
Appetite and food intake	Greater appetite and higher protein intake	Diminished appetite
GI symptoms		Diarrhea or diabetic gastroparesis bouts	Least UFR during gastroenteritis is recommended