Kt/v nightmare

[Tío Riñon]

I completed my adequacy last month and was told by my clinic nurse that I didn't meet the standard (1.7 or above) and needed to re-do the test.  Well, due to the holidays and other events going on in my life, I either forgot to connect the drain bags (I normally drain into the toilet) or completely forgot to do the re-test.  She kept pursuing me to get it done, stating that that her supervisors were on her about the matter and concerned about the DQI.

We were discussing adequacy as part of this month's "education session" and she handed me a sheet.  It showed that my previous Kt/v was 1.99 and my current failure is 1.65 (I had forgotten to ask specifically what the results were last month).  I was none too happy that I was being hassled over 0.05, but she said they won't round up.  She also shared that there is talk of raising the bar to 2.0 or higher in the new year.

I reminded her that there is no scientific basis for Kt/v and it isn't used as a standard in most other countries as it is better to simply ask the patient how s/he feels.  While she agrees, she explained that her hands are tied. 

How is this situation handled at other facilities?  Thanks for allowing me to rant.

[Michael Murphy]

Those numbers are not set locally but the last time the clinic uppped my time from 4:15  to 4:30  I was told CMS changed the clearance requirements. The problem is that CMS is not tolerant of any excuses met the goal or else.

[Shaks24]

***Stupid Question Alert***

Do they do Kt/v tests on Hemo patients as well?

I know on PD every three months we have to bring in 24 hours of chilled urine, our drained dialysis fluid from the night before and they take blood to measure.

Is it the same or similar for Hemo?

[Tío Riñon]

It is NOT a stupid question.     Asking is how we learn!

The answer is yes, there are Kt/v tests for hemo patients; however, it is done during the dialysis session and the required level is different.

I don't know about the specifics, but perhaps someone familiar with procedure can shed more light on the details.

[kickingandscreaming]

There are those who suggest that the Kt/v  is not a good measure of adequacy for PD (or even Hemo). 

http://homedialysis.org/news-and-research/journal-watch/433-new-index-more-accurate-than-kt-v-for-pd-adequacy
http://homedialysis.org/news-and-research/journal-watch/520-kt-v-urea-should-not-be-used-as-an-adequacy-measure-for-pd
http://homedialysis.org/news-and-research/journal-watch/448-are-we-finally-nearing-the-end-of-kt-v

[solid98]

I heard thru the grapevine at my clinic (cough, cough), that a PD patient should use only 1.5 for two days before a collection and drink more fluids. I know my, er, this other patients adequacy, went from 1.87 to 2.48 in one month. About filled that urine collection jug full. The nurse was thrilled.

[kitkatz]

Fresenius wants a KT/V of 1.4  for hemodialysis patients.

[Simon Dog]

Fresenius wants a KT/V of 1.4  for hemodialysis patients.

Yup, and CMS guideline is 1.4.    Kt/V is measured differently for Hemo and PD patients, and the minimum for PD patients is higher.  To confuse things further, a  different Kt/V is used for home hemo patients.

[cassandra]

Huh Kt/v is 1.2

[Vt Big Rig]

WHAT,  I'm doing home hemo and have to meet 2.0!!

[cassandra]

Sorry I meant Kt/v is 1.2 in-centre hemo on 3x a week.
I think home hemo is 2.5 or 2.0 not so sure, that'll be the first time I'm really not interested in what 'made up' figure is the latest flavour of the day.