HOW MUCH FLUID TO REMOVE
WITH DIALYSIS TREATMENTS
programmed by Stephen Z Fadem
INPUT TARGET WEIGHT REMOVAL IN KG
WEIGHT in KG
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. Therefore, dry weight should be accurately assessed and monitored frequently. Patients should be counseled on salt intake, and the bath sodium should not be greater than 138 mEq/L. Patients should be advised to gain less than 2 kg between treatments. An alternative to fluid removal greater than 13/cc/kg/hr is to extend treatment time or to bring the patient back the following day for an additional treatment.
Peter Lundin's Classic Article on Dry weight
Flythe JE, Kimmel SE, Brunelli SM.Rapid fluid removal during dialysis is associated with cardiovascular morbidity and mortality.Kidney Int. 2011 Jan;79(2):250-7.
Allen's Blog - Allen Nissenson. Patient-Focused Quality Pyramid: FluidWise Edition, July 30, 2014
Lindley EJ. Reducing sodium intake in hemodialysis patients. Semin Dial. 2009 May-Jun;22(3):260-3.
KDIGO - Controversies Conference - Cardiovascular Disease in CKD: What is it and What can we do about it? 29-31 October, 2010. London, England
Glassock, R. The Pre-eminent Role for Control of Extra-cellular Volume in Dialysis Therapy. In Issues in Dialysis, pp 138-148. Fadem, SZ ed, Nova Science Publishers, New York, 2013.