Urea Dosing and Administration Guidelines

Hemodialysis Dosing Parameters

The American Journal of Kidney Diseases recommends a target dose for urea clearance of a single-pool Kt/V (spKt/V) of 1.4 per dialysis session when administered three times per week, with a minimally adequate dose of spKt/V of 1.2 per session for hemodialysis patients 1, 2
For hemodialysis patients with residual kidney function (Kr) less than 2 mL/min/1.73 m², the minimally adequate dose of hemodialysis given 3 times per week should be an spKt/V of 1.2 per dialysis 1, 2
The target dose should be an spKt/V of 1.4 per dialysis or URR of 70% for hemodialysis patients 1, 3

The American Journal of Kidney Diseases recommends a minimal "delivered" dose of total small-solute clearance of a total (peritoneal and kidney) Kt/V urea of at least 1.7 per week for CAPD patients 4, 5
Total solute clearance should be measured within the first month after initiating dialysis therapy and at least once every 4 months thereafter for CAPD patients 4, 5

Kt/V urea should be measured within the first month after initiating dialysis therapy and at least once every 4 months thereafter 4
Efforts should be made to monitor and minimize the occurrence of missed or shortened treatments, as these significantly impact outcomes 7, 1
Patient compliance with dialysis schedules significantly impacts outcomes, with missed treatments being an important predictor of mortality and hospitalizations 7

For twice-weekly hemodialysis schedules, patients should have substantial residual kidney function 8, 9
The same minimum levels of spKt/V are recommended for hemofiltration and hemodiafiltration as for standard hemodialysis 8, 9

The stop-dialysate-flow method has not been validated during pediatric dialysis 1, 3
With large dialyzers used at relatively lower blood flow rates, dialyzer outlet blood may still have substantially lower urea concentration than inlet blood after 3 minutes of stopping dialysate flow 1