The Kt/V value demonstrates the dose of hemodialysis (HD). Several studies suggest an association between hemodialysis machine maintenance and patient outcomes. It has been suggested that there is a correlation between dose of dialysis and machine maintenance. However, in spite of the current practice, there are conflicting reports regarding the relationship between dose of dialysis or patient outcome, and machine maintenance. In this article, we will discuss the impact of hemodialysis machine maintenance on dialysis adequacy Kt/V and session performance by building a system dynamics model to evaluate the effect of machine maintenance on session performance. We will also mention the interrelationships of dialysis dose and machine maintenance with respect to these patients.