Dialysis Adequacy — URR Distribution
Target: URR ≥ 65% (KDOQI). Source: static snapshot.Generated: 2026-09-21 23:15
Static snapshot displayed. The live query did not return rows — check the table and column names in
$sql at the top of this file.
Patients with URR
120
Achieved URR ≥ 65%
87.5 %
105 patients
Below 60% (under-dialysed)
5.8 %
7 patients
Peak bin
70 %
53 patients (44.2%)
Distribution of URR (%)
Share of patients
Achievement vs the KDOQI target of URR ≥ 65%
Green = at/above target. Orange = 60–64 (borderline). Red = <60 (under-dialysed).
Automatic analysis
Total patients with a URR result: 120. Data source: static snapshot (live query did not return rows).
Suggested action: Update the query at the top of the file to make this page live.
87.5% of patients achieved URR ≥ 65% — above international benchmarks (typically 80–85%).
Suggested action: Maintain current dialysis prescription, blood-flow and dialyser selection protocols. Publish the protocol unit-wide.
5.8% of patients (7) have URR < 60% — significant under-dialysis.
Suggested action: Review access function and prescription for every one of these patients.
8 patients (6.7%) sit in the 60–64 band — just below target.
Suggested action: These are the highest-yield patients: small prescription changes (longer treatment, larger dialyser, higher Qb) usually move them above 65%.
This page is currently displaying a static snapshot, not live data.
Suggested action: Point the $sql variable at your URR table (see the template comment at the top of the file) to activate live updates.
What URR means
URR (Urea Reduction Ratio) is the percentage fall in blood urea across a single dialysis session:
URR = (pre-urea − post-urea) / pre-urea × 100.
It is a simpler, more widely available alternative to Kt/V, and is the standard adequacy marker in many registries. A URR of 65% corresponds roughly to spKt/V 1.2 — the KDOQI minimum. A URR of 70% corresponds to about spKt/V 1.4, which is the preferred target in many modern guidelines.
Why it matters
- URR < 60%: definite under-dialysis — higher hospitalisation, worse anaemia control, higher mortality.
- URR 60–64%: borderline — small prescription changes usually push these patients above target.
- URR 65–69%: at the KDOQI minimum but below the modern preferred target of 70%.
- URR ≥ 70%: associated with the lowest mortality in observational data, without evidence of harm.
- Very high URR (>80%) without dietitian input may signal muscle wasting — check albumin and nPCR.
What causes a low URR
- Access recirculation or stenosis (fistula or graft)
- Catheter dysfunction / low achievable blood flow
- Blood pump speed below 300–350 mL/min without justification
- Undersized or clotted dialyser
- Shortened or interrupted treatments
- Missed sessions in the preceding month
- Wrong needle gauge or poor cannulation technique
- High body weight with low V-adjusted prescription
What to check when URR is high without apparent cause
- Low muscle mass / malnutrition — check albumin, nPCR, bioimpedance
- Small body size with a large-surface dialyser
- Post-dialysis sample drawn too late or too early
- Pre-dialysis sample drawn after the needle was already running
- Laboratory method drift or sample handling issues
Action plan — improve adequacy unit-wide
- Start with the <60% group. Individual review of every under-dialysed patient within 30 days: access flow, Qb, dialyser, treatment time, missed sessions.
- Then attack the 60–64% band. These 8 patients usually reach ≥65% with modest changes — the highest-yield QI target in the unit.
- Access surveillance. Ultrasound dilution flow every 3 months; pre-emptive angioplasty for stenosis >50%. Low URR is often a silent access problem.
- Prescription audit. Confirm every patient's prescribed Qb, dialyser and treatment time match their actual session record. Drift is common.
- Cannulation training. Retrain on the rope-ladder technique and needle gauge selection. Poor technique alone can cost 5–10 URR points.
- Missed/shortened treatment tracking. Every missed or shortened session lowers the monthly URR — track it against this page.
- Monthly adequacy rounds. Nephrologist + head nurse + technician; review every patient <65% and every patient with a fall >5 points from their own baseline.
- Post-dialysis sampling protocol. Standardise the stop-pump, slow-flow method and a single validated lab. Poor sampling causes as many "low URR" results as actual under-dialysis.
- Consider switching the unit target from 65% to 70%. Modern evidence supports 70% as the preferred target; the 65–69 band represents an opportunity, not a success.
Distribution table
| URR band (%) | Patients | % | Achievement vs ≥65% | Distribution |
|---|---|---|---|---|
| <50 | 0 | 0% | Below | |
| 55 | 7 | 5.8% | Below | |
| 60 | 8 | 6.7% | Borderline | |
| 65 | 34 | 28.3% | At target | |
| 70 | 53 | 44.2% | At target | |
| 75 | 10 | 8.3% | At target | |
| 80 | 8 | 6.7% | At target | |
| Total | 120 | 100% | 87.5% ≥ 65% |