Why Do Dialysis Patients Have a Max UFR? Let me count the ways with Dialysis Nurse Lindsey 

Why Do Dialysis Patients Have a Max UFR? Let me count the ways with Dialysis Nurse Lindsey
Max UFR= Maximum Ultrafiltration Rates = Max amount of fluid that can be removed in a dialysis treatment
Max UFR = ml/kg/hr
Max UFR Goals and Dry Weights
I want to clear a few things up
Max UFR means the maximum amount of fluid we can remove in 1 dialysis treatment
UFR = ultrafiltration rate
If you have questions on that please click on this What is UFR on the top right of your screen
1 L = 1 KG, 1 KG = 1 L
If I remove 2 Liters during dialysis
How much weight am I removing?
RIght, 2 kg in weight
Back to Max UFR.
The Max UFR order looks like this:
• 10 ml/kg/hour
• 11 ml/kg/hour
• 12 ml/kg/hour
• 13 ml/kg/hour
Per CMS guidelines (the people that reimburse us) The maximum amount of fluid we can remove during dialysis for reimbursement is 13 ml/kg/hour
But it’s not all about the money.
The National Kidney Foundation found with goals greater than 13 ml/kg/hour there is increased risk for morbidity and mortality.
OMG Lindsey what is with all the fancy words.
High goals leads to an increased risk of hospitalizations, cardiac events, not tolerating dialysis and death.
That’s enough of that, lets get to the fun part.
You are going to need your calculator.
We have the order 10ml/kg/hour
Lets break that down
10 ml--that’s the fluid part, one of the numbers you will key into your calculator
kg-that is your patients weight. Where I work, we use the weight they come in at. So like they just stepped on the scale, their wieght is 85 kg. I’m going to use that number
hour: that is their treatment time in hours. So if they are on the machine for 3.5 hours, I’m going to key in 3.5 into my calculator. If their treatment time is 3 1/4 hours, i’m going to key in 3.25hours.
We will multiply these numbers
ml/kg/hour
10ml times 85 times 3.5 hours
2975 ml/kg/hour (treatment time)
Lets do another one
11 ml/kg/hour
Patient is 110 kg
They are on the machine for 3.5 hours
11 x 110 x 3.5
max goal is 4235 mls/treatment
how much is this an hour?
4235/3.5
1210 ml/hour
Holy moly.
Just because you can remove this much, doesn’t mean you have to.
I have anxiety if I remove more than 1 liter per hour on a patient.
I will always use a crit line on these patients-and most of the time I end up decreasing their goal
And this comes from experience. Any many patients will agree with you. patients that have been on dialysis learn how much fluid they can remove and still have a good day. Their max goal might be 3.5 liters, but if we do that, they are going to have a crap day and be in bed all day and have to sleep it off. They might tell you 2.5 L is the most they can tolerate and have a good day.
And some of the other patients I’ll look and maybe they had 4 Liters removed on Monday, I’m struggling to pick a goal. And I’ll be like, we removed 4 L on Monday, how did that feel? And they might tell you great, or they might be like, oh man, i was in bed all day. Educate them, that’s from the fluid removal , i think we got a
I want you remember that you don’t need to get to their dry weight on Monday, you have all week.
One of the perks of this limit to fluid removal is it Helps enforce fluid restriction.
Example:
Doctors orders:
Max UFR = 10 ml/kg/hr per treatment
Patient Weight 100 kg
Treatment time 3 hours
Max UFR = 10 ml * 100kg * 3 hours
Max UFR = 3000 ml per treatment
The maximum UFR (fluid/weight) I can remove per dialysis treatment is 3000 ml/treatment.
Max UFR was first introduced to our dialysis clinic a little over 5 years ago. New research proved that long term high fluid removal goals increased the patients risk for cardiac death and problems toleratined dialysis in the future.
A lot of this points to decreased cardiac output, hypotension, and intradialytic symptoms at dialysis. Cardiac arrest.
DISCLAIMER: This video is intended for education purposes only and is not intended as medical advice
DISCLAIMER: Links included in this description might be affiliate links. If you purchase a product or service with the links that I provide I may receive a small commission. There is no additional charge to you! Thank you for supporting my channel so I can continue to provide you with free content each week!
00:00 Dry Weights and UFR
00:55 Practice Max UFR Goals
4:00 Hourly Fluid Removal
07:15 When to Notify Provider
08:45 Dry Weights