Dialysis Quality Measures Explained: Kt/V, Fistulas, SMR and More

What each number on a dialysis center's report card means: death and hospitalization rates, infections, Kt/V adequacy, fistula vs. catheter, calcium and phosphorus, and transplant waitlisting.

Updated 2026-09-29. Sources: CMS, Medicare and federal regulations, linked inline.

Dialysis report cards are full of abbreviations. This guide explains every measure shown on center pages here, what a good number looks like, and why it matters to you.

Rates and ratios: how to read them

Some measures are rates per 100 patient-years (for example, 22 deaths per 100 patient-years means that if 100 patients were treated for a full year, about 22 would die). Others are ratios comparing what happened at the center to what CMS expected for its particular patients:

• 1.00 = as expected
• Below 1.00 = fewer events than expected (good for deaths, hospital stays, infections)
• Above 1.00 = more events than expected

These are risk-adjusted, so a center that treats older or sicker patients is compared fairly. CMS also labels each center “better than expected”, “as expected” or “worse than expected” after accounting for statistical uncertainty. We show that label under each measure.

Outcomes

• Patient deaths (mortality rate). The most important outcome. Dialysis patients face high risk from heart disease and infection; good centers manage fluid, blood pressure and anemia closely.
• Hospital admissions. How often patients are admitted. Fewer admissions usually mean better management between treatments.
• Readmitted within 30 days. The share of hospital discharges followed by another admission within 30 days. Good follow-up after a hospital stay lowers it.
• Emergency room visits, overall and within 30 days of a hospital stay. Also a sign of how well problems are caught early.
• Blood transfusions. Transfusions can make a future kidney transplant harder, so centers try to manage anemia with medication instead.
• Bloodstream infections. Reported to the CDC. Most are linked to catheters and are largely preventable with strict hygiene.

Vascular access

To do hemodialysis, you need a way to get blood out and back in quickly:

• AV fistula — your own artery and vein joined surgically in the arm. It lasts longest and has the lowest infection risk. Higher percentages are better.
• Graft — a soft tube joining artery and vein; a good second choice.
• Catheter — a tube in a large vein in the neck or chest. Useful short-term but with much higher infection risk. The measure shown is the share of patients who have had a catheter for 90 days or more; lower is better.

Dialysis adequacy (Kt/V)

Kt/V measures how much waste is cleared during dialysis relative to the size of your body. Targets are at least 1.2 per treatment for hemodialysis and 1.7 per week for peritoneal dialysis. Nearly all centers hit these for most patients, so a low number stands out.

Minerals: calcium and phosphorus

Failing kidneys cannot balance minerals. High calcium (above 10.2 mg/dL) and very high phosphorus (above 7.0 mg/dL) are linked to hardened blood vessels and heart problems. Diet, binders and medication help; lower percentages are better.

Transplant waitlisting

A kidney transplant usually means a longer and better life than dialysis. Two measures show how well a center gets patients evaluated and listed:

• Patients on the transplant waitlist — the share of the center’s patients currently waitlisted.
• New patients waitlisted — a ratio comparing how many new patients got on the list within their first year to what was expected. Higher is better for both.

If a transplant is a possibility for you, weigh these heavily.

Patient survey (ICH-CAHPS)

In-center hemodialysis patients are surveyed twice a year about their kidney doctors, the center staff, how well they are informed, and the center overall. Scores run 0–100; higher is better. CMS publishes them only for centers with at least 30 completed surveys.

How we combine them

Our 0–100 score ranks each center against all others on every one of these measures it has, then averages the rankings. No single measure tells the whole story, so look for patterns: a center that is “worse than expected” on several outcomes deserves hard questions. Questions to ask a dialysis center.

Sources: CMS Dialysis Facility Care Compare data dictionary, National Kidney Foundation KDOQI guidelines, CDC: Dialysis safety.