UFR Monitoring & Staff Education

Form HD-CL-006-F4 · Hemodialysis Unit – [Hospital Name]

Month/Year: _________ Unit: _________

A Why UFR Matters – Staff Education UPDATED

KDOQI 2015 / KDIGO 2025 Limit: UFR must be ≤13 mL/kg/hr

⚠️ Higher rates cause:

Intradialytic Hypotension (IDH) – symptomatic BP drops requiring intervention
Cardiac stunning and heart failure – myocardial ischemia during rapid fluid removal
Increased mortality – 30% higher death risk if average UFR >13 mL/kg/hr (Flythe et al., Kidney Int 2011)
Cramps, nausea, "wiped out" feeling – reduced quality of life post-HD
Vascular access thrombosis – hemoconcentration and reduced flow

KDIGO 2025 Update NEW: UFR >13 mL/kg/hr is now considered a quality indicator requiring documentation of clinical justification and a mitigation plan. Chronic UFR >13 should trigger review of dry weight, treatment time, and interdialytic weight gain.

B UFR Calculation

UFR (mL/kg/hr) = UF Goal (L) × 1000 ÷ Treatment Time (hrs) ÷ Post-Dialysis Weight (kg)

UF Goal = Pre-Weight – Dry Weight + Rinseback (0.5L)

Example: Pre-Weight 80 kg, Dry Weight 75 kg, Time 4 hrs, Post-Weight 75 kg
UF Goal = 80 – 75 + 0.5 = 5.5 L
UFR = 5.5 × 1000 ÷ 4 ÷ 75 = 18.3 mL/kg/hr → EXCEEDS LIMIT – STOP

Within Limit: UF Goal 3.0 L, Time 4 hrs, Post-Wt 75 kg
UFR = 3.0 × 1000 ÷ 4 ÷ 75 = 10.0 mL/kg/hr → Within KDOQI limit

C Daily UFR Tracking Log UPDATED

Complete for every patient every treatment. Any UFR >13 requires MD notification and documentation.

Date	Patient	Pre-Wt (kg)	Dry Wt (kg)	UF Goal (L)	Time (hrs)	Post-Wt (kg)	UFR (mL/kg/hr)	≤13?	MD Notified (if >13)	RN Initials
								Yes No
								Yes No
								Yes No
								Yes No
								Yes No
Additional rows as needed – copy template for each treatment day

D Strategies to Reduce UFR UPDATED

📉 Reduce IDWG

Dietary Na restriction (<2g/day)
Fluid education – target <4% EDW
Review medications (diuretics if residual renal function)

⏱️ Increase Treatment Time

Extend session by 30-60 min
Consider frequent HD (4-6x/week)
Nocturnal HD if appropriate

⚖️ Reassess Dry Weight

Monthly clinical assessment
Bioimpedance if available
Probe dry weight if IDH or edema

🩺 Patient-Specific Modifications

Isolated UF first hour for cardiac patients
Cooler dialysate (35.5°C) for IDH-prone
Consider sodium profiling (with caution)

KDIGO 2025 Recommendation NEW: For patients with consistently high UFR, develop a written action plan including at least two of the strategies above. Document in monthly review (HD-CL-006-F3) and update prescription (HD-CL-006-F1).

E Monthly UFR Summary UPDATED

Total Treatments This Month:

Total Treatments with UFR >13:

% UFR >13: %

Patients with Consistent UFR >13 (>3 sessions/month):

Action Plan for High UFR Patients:

QAPI Target for Next Month: <10% treatments >13 100% of >13 with MD notification documented

Staff Education Sign-Off

I have read and understood the UFR limit (≤13 mL/kg/hr), the risks of exceeding it, and the strategies to reduce UFR. I can correctly calculate UFR and know to notify the MD if UFR >13.

Staff Name (Print)	Signature	Date	UFR Calculation Test Pass (100%)

In-Charge RN Verification: Date:

Form HD-CL-006-F4 · Updated June 26, 2026 KDIGO 2025 · KDOQI 2015 · MOH-Jordan 2023 aligned
This form serves as staff education, daily tracking, and monthly summary for UFR compliance. All staff must complete education annually.

HD-CL-006-F4 · Version 2026-06-27 · Hemodialysis Unit

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Aligned with KDOQI, AAMI/ISO, CDC, MOH-Jordan 2023, JCI 8th Ed.