We Underdialyze Women and Smaller Patients

In women, children, and smaller adults, dialysis adequacy targets based solely on Kt/V might result not only in shorter treatments with inadequate fluid removal and undesirably rapid ultrafiltration rates, but also in less than optimal removal of small and middle molecular weight solutes if fractional removal is considered in relation to body surface area. The outcomes evidence for this is not definitive, but is suggested by a prespecified secondary analysis of the randomized HEMO trial results, and is supported by observational data. Also, there is evidence from normal renal physiology that in healthy humans of different body size, glomerular filtration rate (GFR) scales more closely to body surface area than to total body water. With these factors in mind, time on HD may need to be greater than that predicted by standard KT/V measurements to maximize survival in women and in smaller patients.