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National Kidney Foundation

National Kidney Foundation

What Is Ultrafiltration in Dialysis?

What Is Ultrafiltration in Dialysis?

Learn how to get the most out of ultrafiltration during hemodialysis and peritoneal dialysis.


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Ultrafiltration is a critical component of dialysis, helping people with kidney disease remove excess fluid from their bodies. Since kidneys naturally filter and regulate fluid balance, dialysis replicates this function when your kidneys can no longer do it effectively. The process is essential for maintaining fluid balance and preventing complications like swelling, high blood pressure, and heart strain. Learn about ultrafiltration, why it’s important, and how you can optimize the process during dialysis.*

Ultrafiltration in Hemodialysis

Hemodialysis removes fluid using a dialysis membrane that acts as a semipermeable barrier. The process relies on pressure differences between your blood and the dialysate, a fluid used in dialysis. The fluid naturally moves from an area of higher pressure (the blood) to an area of lower pressure (the dialysate), reducing excess fluid.

The ultrafiltration rate (UFR) determines how quickly fluid is removed. Dialysis staff set this rate based on your fluid weight gain since your last treatment. If too much fluid accumulates between treatments, removing it too quickly can lead to:

  • Low blood pressure, 
  • Cramping,  
  • Dizziness, and 
  • Fatigue.  

In such cases, a longer or additional dialysis session may be required to remove excess fluid safely.

Tips for effective ultrafiltration in hemodialysis include:

  • Complete all dialysis sessions as prescribed; shortening treatments can result in fluid overload.
  • Limit your sodium intake to reduce thirst and fluid retention.
  • Monitor your fluid intake to prevent excessive fluid buildup between sessions.

Ultrafiltration in Peritoneal Dialysis

Peritoneal dialysis (PD) uses the peritoneal membrane inside the abdomen to filter fluid and waste. The dialysate for PD contains dextrose (a type of sugar), which helps draw fluid from the blood into your peritoneal cavity. The amount of dextrose in the solution determines how much fluid is removed.

PD solutions are available in different dextrose concentrations (1.5%, 2.5%, and 4.25%), and clinicians adjust the strength based on your target weight. Higher concentrations remove more fluid, but too much high-dextrose use can cause inflammation and long-term damage to the peritoneal membrane.

Some best practices for effective ultrafiltration in PD are:

  • Complete all prescribed PD exchanges to ensure proper fluid removal.
  • Use the appropriate PD solution as instructed by your healthcare provider.
  • Limit salt and fluid intake to reduce the need for high-dextrose solutions.

Preventing Ultrafiltration Failure

Ultrafiltration failure occurs when insufficient fluid crosses the peritoneal or dialysis membrane. Several factors can contribute to this issue, including:

  • Uremia (high blood urea nitrogen levels), 
  • Peritonitis (infection of the peritoneal membrane), and 
  • Prolonged use of high-dextrose PD solutions.

To prevent ultrafiltration failure:

  • Clean and maintain the proper catheter care to avoid infections like peritonitis.
  • Follow the dietary guidelines to manage sodium and fluid intake.
  • Communicate with your healthcare team if fluid retention becomes an issue.

By understanding and managing ultrafiltration, patients undergoing dialysis can achieve better health outcomes and maintain a stable fluid balance, reducing complications and improving overall well-being.

*National Kidney Foundation. (n.d.). Ultrafiltration. https://www.kidney.org/kidney-topics/ultrafiltration 

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