Epidemiologic studies examining ultrafiltration rate (UFR) and adverse outcomes in thrice-weekly hemodialysis patients have linked rapid UFRs to higher risks of mortality,1,2 mesenteric ischemia,3 and new-onset dementia.4 Data from mechanistic studies support these findings, demonstrating that hemodialysis-induced circulatory stress can cause ischemic injury to end-organs including the heart, gut, brain, and kidneys.5 Based on consistent observational data and strong biological plausibility, the United States (US) Centers for Medicare & Medicaid Services incorporated a UFR reporting metric into the 2020 End-Stage Renal Disease Quality Incentive Program, heightening the dialysis community’s awareness of fluid removal practices.