The association of standard Kt/V and surface area-normalized standard Kt/V with clinical outcomes in hemodialysis patients

Pattharawin Pattharanitima, Kinsuk Chauhan, Osama El Shamy, Kumardeep Chaudhary, Shuchita Sharma, Steven G. Coca, Girish N. Nadkarni, Jaime Uribarri, Lili Chan

Research output: Contribution to journalArticlepeer-review


Introduction: A previous study demonstrated that the surface area-normalized standard Kt/V (SAstdKt/V) was better associated with mortality than standard Kt/V (stdKt/V). This study investigates the association of SAstdKt/V and stdKt/V with mortality, anemia, and hypoalbuminemia in a larger patient cohort with a longer follow-up period. Methods: We included adult patients on thrice-weekly hemodialysis in the USRDS database and excluded amputated patients. StdKt/V and SAstdKt/V were calculated from the available single-pool Kt/V. Patients were categorized into five groups according to their stdKt/V and SAstdKt/V: <2.00, 2.00–2.19, 2.20–2.39, 2.40–2.59, and ≥2.60. Hazard ratios (HR) and odds ratios (OR) were calculated using Cox and logistic regression analysis respectively. Findings: There were 507,656 patients included in the analysis. The patients had a median age of 65.5 years with a median follow-up period of 2 years. Thirty-four percent died during follow-up. HRs for mortality progressively decreased as SAstdKt/V increased in both unadjusted and adjusted models. Unlike SAstdKt/V, HRs were the lowest in the categories with stdKt/V of 2.40–2.59 and they increased in the higher stdKt/V category. The adjusted HR for SAstdKt/V vs. stdKt/V were 0.68 vs. 0.62 in the category of 2.40–2.59, and 0.63 vs. 0.73 in the category of ≥2.60. The adjusted ORs for anemia progressively decreased as SAstdKt/V increased, whereas ORs decreased to the lowest in stdKt/V category 2.40–2.59 and increased in the ≥2.60 category. The adjusted ORs for hypoalbuminemia progressively decreased as SAstdKt/V and stdKt/V increased which were both 0.45 in 2.40–2.59 category and decreased to 0.29 and 0.42 in the ≥2.60 category. Discussion: SAstdKt/V is better associated with mortality, anemia, and hypoalbuminemia than stdKt/V. SAstdKt/V is a better parameter in defining hemodialysis dosing which can be calculated by an available online tool. Further studies to determine the optimal SAstdKt/V dose required to achieve improved clinical outcomes with better cost-effectiveness are needed.

Original languageEnglish
Pages (from-to)495-505
Number of pages11
JournalHemodialysis International
Issue number4
StatePublished - 1 Oct 2020


  • Adequacy of dialysis
  • anemia
  • nutrition
  • survival


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