KDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 Update

Michael Rocco, John T. Daugirdas, Thomas A. Depner, Jula Inrig, Rajnish Mehrotra, Michael V. Rocco, Rita S. Suri, Daniel E. Weiner, Nancy Greer, Areef Ishani, Roderick MacDonald, Carin Olson, Indulis Rutks, Yelena Slinin, Timothy J. Wilt, Holly Kramer, Michael J. Choi, Milagros Samaniego-Picota, Paul J. Scheel, Kerry WillisJessica Joseph, Laura Brereton

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373 Scopus citations


The National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) has provided evidence-based guidelines for all stages of chronic kidney disease (CKD) and related complications since 1997. The 2015 update of the KDOQI Clinical Practice Guideline for Hemodialysis Adequacy is intended to assist practitioners caring for patients in preparation for and during hemodialysis. The literature reviewed for this update includes clinical trials and observational studies published between 2000 and March 2014. New topics include high-frequency hemodialysis and risks; prescription flexibility in initiation timing, frequency, duration, and ultrafiltration rate; and more emphasis on volume and blood pressure control. Appraisal of the quality of the evidence and the strength of recommendations followed the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach. Limitations of the evidence are discussed and specific suggestions are provided for future research.

Original languageEnglish (US)
Pages (from-to)884-930
Number of pages47
JournalAmerican Journal of Kidney Diseases
Issue number5
StatePublished - Nov 1 2015

Bibliographical note

Funding Information:
Rajnish Mehrotra, MD, is Professor of Medicine at the University of Washington and section head of nephrology at the Harborview Medical Center in Seattle, WA. He is currently the Associate Editor for the Journal of the American Society of Nephrology and was Chair of the Dialysis Advisory Group of the ASN from 2009 to 2015. He has been Treasurer of the International Society for Peritoneal Dialysis since 2014 and is currently President of the North American Chapter of the International Society for Peritoneal Dialysis. He was awarded the John Maher Award by the International Society for Peritoneal Dialysis in 2006. Dr Mehrotra’s research support includes, among others, grants from the NIH and Patient Centered Outcomes Research Institute (PCORI). His research interests include comparative effectiveness of dialysis modalities, biological determinants of peritoneal membrane function, and patient-reported outcomes in patients undergoing maintenance dialysis. He has published/co-authored over 200 articles and/or book chapters, with an H-index of 44. He has served as an Associate Editor of Peritoneal Dialysis International and NephSAP and as a section editor for Clinical Nephrology. He is currently a member of the editorial board for Kidney International, American Journal of Kidney Diseases, Clinical Journal of American Society of Nephrology, and Journal of Renal Nutrition. He has served as Chair of the Education Committee and Membership Committee of the International Society for Peritoneal Dialysis and a member of the Council of the Society in the past.

Funding Information:
Rita S. Suri, MD, MSc, FRCPC, is an Associate Professor, Clinician-Researcher, and Clinical Nephrologist at the Centre Hospitalier de l'Université Montréal (CHUM, University of Montreal). She received formal training in observational methodology and randomized trials at Western University and currently holds a career research scholarship from the Fonds de la Recherche en Santé du Quebec (FRSQ). She has published extensively in the field of intensive HD therapies in the form of journal articles, book chapters, and clinical practice guidelines and was intensively involved as a member of the Steering Committee of the FHN Trials. She is currently Chair of the Canadian Nephrology Trials Network and serves as an internal reviewer for the Canadian Institutes of Health Research Randomized Controlled Trials Committee. Her ongoing research program continues to focus on improving renal replacement therapy for patients with ESRD.

Funding Information:
Financial Disclosure: Dr Suri holds an unrestricted Extramural Research Grant from Baxter Inc.

Funding Information:
Financial Disclosure: Research and medical director funding from DCI.

Funding Information:
Financial Disclosure: Consultant funding from Galzxo Smith Kline, Data Monitoring Safety Board, and Genetech Advisory Board.

Funding Information:
Milagros (Millie) Samaniego-Picota, MD (Vice Chair, Policy), is a professor of medicine as well as Medical Director of the Kidney and Kidney-Pancreas Transplant Program and the Transplant Nephrology Fellowship at University of Michigan Medical School. Dr Samaniego received her MD degree from the University of Panama and was an intern and resident in internal medicine at Baylor College of Medicine in Houston, TX, where she served as Chief Resident from 1993-1994. In 1994, Dr Samaniego started postdoctoral training in nephrology and immunopathology at the Johns Hopkins School of Medicine in Baltimore, MD. During her fellowship, Dr Samaniego received the ASTP-Sandoz Fellowship Award in Transplantation in addition to grant support from the Maryland Chapter of the NKF. Until 2006, she was supported by a Scientist-Development Grant of the American Heart Association. Dr Samaniego is former Associate Editor of the American Journal of Transplantation, has served on the Basic Science, Education, and the Women's Health committees of the American Society of Transplantation (AST). She has also participated as lecturer (since 2004) and Chair of the AST Fellows Symposium since 2009 and the 2009-2010 AST Winter Symposium. She has been an abstract reviewer for the American Congress of Transplantation for the past 14 years. She has been an ad hoc reviewer for all major transplantation journals since 2000. Dr Samaniego's clinical and research interests focus on experimental and clinical antibody-mediated rejection, desensitization protocols, and the care of highly sensitized patients.

Funding Information:
Financial Disclosures: Dr Samaniego reports research grants and speakers bureau fees from Alexion Pharmaceuticals and consultant funding from Sanofi and Thermo-Fisher Corporation.

Publisher Copyright:
© 2015 National Kidney Foundation, Inc.


  • Clinical Practice Guideline
  • Hemodialysis
  • adequacy
  • evidence-based recommendation
  • hemodialysis frequency
  • hemodialysis prescription
  • hemofiltration
  • initiation
  • treatment time
  • urea modeling

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