During the next decade, about one million people in the United States are expected to start dialysis therapy.1 The majority of these people will be treated with a fixed-dose (single-pool Kt/Vurea [spKt/Vurea] ≥ 1.2) thrice-weekly hemodialysis regimen irrespective of whether they are just starting dialysis therapy (incident) or have been receiving dialysis for some time (prevalent) and without consideration for residual kidney function (RKF). Although the regulatory agencies might consider this hemodialysis regimen as “standard of care” and “adequate,” it is by no means perfect.