Kt/V underestimates the hemodialysis dose in women and small men

E.M. Spalding, S.M. Chandra, A. Davenport, Ken Farrington

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    80 Citations (Scopus)


    Current guidelines suggest a minimum Kt/V of 1.2 for three weekly hemodialysis sessions; however, using V as a normalizing factor has been questioned. Parameters such as weight^0.67 (W0.67) and body surface area (BSA) that reflect the metabolic rate may be preferable. To determine this, we studied 328 hemodialysis patients (221 male) with a target Kt/V of 1.2. Using this relationship and the individual's Watson Volume, we calculated the Kt, Kt/BSA, and Kt/W^0.67 equivalent to the target and measured the effects of body size and gender on these parameters for each patient. The target corresponded to a range of equivalent Kt/BSA and Kt/W^0.67 each significantly higher in males than females and in larger than smaller males. V/BSA and V/W^0.67, the conversion factors of Kt/V to Kt/BSA and Kt/W^0.67 respectively, were significantly greater in males than females and heavier than lighter men. Our study shows that if Kt/BSA and Kt/W^0.67 reflect the true required dose, prescribing a target Kt/V of 1.2 would underestimate this in females and in small males. Further work is required to develop clinical outcome-based adequacy targets.
    Original languageEnglish
    Pages (from-to)348-355
    JournalKidney International
    Issue number3
    Publication statusPublished - 2008


    • hemodialysis
    • adequacy
    • Kt/V
    • metabolic size
    • body surface area
    • total body water


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