Table 1.

Categories of eligibility for dialysis dose reduction in patients on maintenance dialysis

Assume patients are modifying their behaviors (e.g., dietary adherence) to the best of their ability. Other criteria to consider include
  • residual kidney function/urine output (responsiveness to diuretics for potassium or volume management);

  • ability to tolerate potassium resin binders; and

  • ability to tolerate further dietary restrictions and dialysate [K] reduction.

Patient CharacteristicsVolume StatusPotassium Status
Category 1Stable, suitable for reduced frequency HDControlled: IDWG<4%andControlled: serum potassium <5 mmol/L and dialysate potassium >2 mmol/L
Category 2May be suitable for shorter duration HD runsControlled: IDWG<4%andUncontrolled: serum potassium >5 mmol/L or dialysate potassium ≤2 mmol/L
Category 3Intermediate: physician discretion to be used for reduced duration HDBorderline: IDWG 4% or 4 kg and/or recent admission for volume overloadand/orUncontrolled: dialysate potassium ≤2 mmol/L or serum potassium ≥5 mmol/L
Category 4Unsuitable for short or less frequent HDUncontrolled: IDWG >4% or >4 kgandUncontrolled: serum potassium >5 mmol/L or dialysate potassium ≤2 mmol/L
Category 5Case-by-case assessment: use physician discretion when deciding on dialysis frequency/duration. Patients who started HD within the past 1 mo (noting that new patients may have delayed longer than usual to start during pandemic surge, and may be metabolically and/or hemodynamically unstable and require frequent dialysis to stabilize). Patients on HD four to five times per week, but have acceptable potassium or IDWG
  • HD, hemodialysis; IDWG, interdialytic weight gain.