Hemodialysis Adequacy and Mortality

Abstract

Introduction: Dialysis adequacy, measured by Kt/V and urea reduction ratio (URR), correlates with patient survival. Methods: Review of 30 studies (1990–2023) examining associations between delivered dialysis dose and clinical outcomes. Results: Single-pool Kt/V ≥1.4 reduced mortality by 22% compared to <1.2. However, beyond Kt/V 1.6, no additional survival benefit was observed. Frequent hemodialysis (6x/week) improved quality of life but showed equivocal mortality benefit. Discussion: Achieving minimum adequacy targets is essential, but higher doses do not linearly improve outcomes. Session length and volume control may matter equally. Conclusion: Minimum Kt/V ≥1.4 should be achieved, with emphasis on time and blood pressure control.