Are you receiving adequate dialysis? How's your Kt/V?

[Zach]

Is it difficult for you to keep the same Kt/V each month?  Please share your experiences.
How many hours are you on dialysis?  How many times a week?

You may be asking, what is the Kt/V?

K stands for the dialyzer clearance, expressed in milliliters per minute (mL/min)  You can get this information from your doctor.

t stands for treatment time

Kt, the top part of the fraction, is clearance multiplied by time, representing the volume of fluid completely cleared of urea during a single treatment

V, the bottom part of the fraction, is the volume of water a patient’s body contains

Example: If the dialyzer’s clearance is 300 mL/min and a dialysis session lasts for 180 minutes (3 hours), Kt will be 300 mL/min x 180 min. This equals 54,000 mL, or 54 liters.

Kt = 300mL/min x 180min
Kt = 54,000mL = 54 liters

The body is about 60 percent water by weight. If a patient weighs 70 kilograms (154 lbs), V will be 42 liters.

V = 70 kg x .60 = 42 liters

So the ratio (K x t) to V, or Kt/V, compares the amount of fluid that passes through the dialyzer with the amount of fluid in the patient’s body. The Kt/V for this patient would be 1.3.

Kt/V = 54/42 = 1.3

This information is from:
http://kidney.niddk.nih.gov/kudiseases/pubs/hemodialysisdose/


The National Kidney Foundation (U.S.A.) sponsors the Kidney Disease Outcomes Quality Initiative or KDOQI, which provides evidence-based clinical practice guidelines:

Minimum Delivered Dose of Hemodialysis (Adults Evidence, Children Opinion)
The dialysis care team should deliver a Kt/V of at least 1.2 (single-pool, variable volume) for both adult and pediatric hemdialysis patients. For those using the URR, the delivered dose should be equivalent to a Kt/V of 1.2, ie, an average URR of 65%. However, URR can vary substantially as a function of fluid removal.

Prescribed Dose of Hemodialysis (Opinion)
To prevent the delivered dose of hemodialysis from falling below the recommended minimum dose, the prescribed dose of hemodialysis should be Kt/V 1.3. In terms of URR, a Kt/V of 1.3 corresponds to an average URR of 70%, but the URR corresponding to a Kt/V of 1.3 can vary substantially as a function of ultrafiltration.

Frequency of Measurement of Hemodialysis Adequacy (Opinion)
The delivered dose of hemodialysis should be measured at least once a month in all adult and pediatric hemodialysis patients. The frequency of measurement of the delivered dose of hemodialysis should be increased when:

1. Patients are noncompliant with their hemodialysis prescriptions (missed treatments, late for treatments, early sign-off from hemodialysis treatments, etc.).

2. Frequent problems are noted in delivery of the prescribed dose of hemodialysis (such as variably poor blood flows, or treatment interruptions because of hypotension or angina pectoris).

3. Wide variability in urea kinetic modeling results is observed in the absence of prescription changes.

4. The hemodialysis prescription is modified.

For more information (though a bit more complicated) please visit:
http://www.kidney.org/professionals/kdoqi/guidelines_updates/doqiuphd_ii.html#4

[BigSky]

1.4

Personally I want it to be higher but the doc says its fine.  I would take more time as to me the day is shot anyway. 

[Epoman]

When I was in-center my Kt/V was about 1.2 to 1.3 The doctor always wanted me to run longer but 3 hours was enough for me, I tried 4 hours and I just could not stand it.

On NxStage they measure the Kt/V differently, currently mine .76 but that is daily 5 X week, they say that is VERY good.

[angieskidney]

mine used to be a bit higher but lately it is between 1.4 and 1.7 on average for me.

[SOMBERFACE]

Mine was 1.7 on my last test. But epoman kt/v is kt/v how can they come up with different results?

[Epoman]

Mine was 1.7 on my last test. But epoman kt/v is kt/v how can they come up with different results?

Not sure except that it is measured differently than conventional in-center or traditional home-hemo. But I am getting better dialysis now than I was at in-center. My Kt/V is higher.

I need to ask NxStage about that and I will post the technical answer here when I find out.

[MelissaJean]

I had my first adequacy test (doing PD- 9 hrs/night) and the nurse mentioned in passing that it the number was 4.1.    I wanted to ask more but was in a rush to get home and figured I would ask the doctor the next day.... but my appointment got cancelled. 

 Is 4.1 possible or did I misunderstand?  Why is it so high?  Should I be happy or worried?

[Rerun]

If we are talking Kt/V then 1.40 or higher is optimal on Hemo.  I'm not sure what numbers are for PD.  Maybe you should confirm what you heard and what it was for.

[goofynina]

Mine was 1.5 and they said it should be 1.8, come on, whats .3 measly little numbers,  well, now, they have me on the cycler 11 hours and now i have to have 3000 ml dwelling in me 5 times with one manual drain... crazy huh? 

[kitkatz]

oh man, Goofynina. 

[Panda_9]

I feel sorry for you goofinya, sounds almost like my PD regime. Constantly 9 months pregnant! 
I dont think some of the docs here like the kt/v as a way of measuring adequacy. I think Ive had mine done once or twice since Ive been home.

[Zach]

I dont think some of the docs here like the kt/v as a way of measuring adequacy. I think Ive had mine done once or twice since Ive been home.

URR is another method.  It's easier to understand and figure out mathematically.  Here's more:

The reduction in urea as a result of dialysis, or the URR, is one measure of how effectively a dialysis treatment removed waste products from the body. URR stands for urea reduction ratio, but it is commonly expressed as a percentage.

Example: If the initial (predialysis) urea level was 50 mg/dL and the postdialysis urea level was 15 mg/dL, the amount of urea removed is 35 mg/dL.

50 mg/dL - 15 mg/dL = 35 mg/dL

The amount of urea removed (35 mg/dL) is expressed as a percentage of the predialysis urea level (50 mg/dL).

35/50 = 70/100 = 70%

Although no fixed number can be said to represent an adequate dialysis, it has been shown that patients generally live longer and have fewer hospitalizations if the URR is at least 60 percent. For this reason, some groups advising on national standards have recommended a minimum URR of 65 percent.

From the web site:
http://kidney.niddk.nih.gov/kudiseases/pubs/hemodialysisdose/

[Zach]

This message was by mistake ... oops!     

[slothluvchunk]

Mine can vary by more than .4 from say, 1.3 to 1.75. 
Unfortunately there's a bit of room for error in the test, and I wouldn't get yourself in a position of receiving more "tests" to look for problems in your access due to one low Kt/V. 
Depending on flow rates during treatment, exact time you're on the machine, and even who draws it, the Kt/V results can really vary.

[kevno]

In the UK I have never had how good my dialysis was by Kt/V? We use URR's mine about 63%, the Unit aims for 70 -75% so not a good dialysis that day? Blood is taken at the start of dialysis and at the end of dialysis and both results compared to see how well you are getting dialyized. It gets done once a month so it is on the day?

[nkviking75]

I run about 1.0, which is why I am on hemo 4 times a week and 4 hours at a time.  (Had the option of 3 days/5 hours, but I'm climbing the walls after about 2 1/2 hours in the chair as it is.  I'd rather take the extra day.  They tell me that's probably better for me anyway.)  They've tried all sorts of methods to boost it, including using a dual filter arrangement for awhile.  For a long time I was about .85-.9, so I have actually improved.  For me, going from a fistula to a graft made a difference.  They tell me the best thing I could do for my Kt/V is lose weight, and I don't have any trouble believing that.  So I battle on.

[Zach]

Four treatments a week is real good.  I'm glad they gave you that option.     

[angieskidney]

Oh ya I was gonna post what mine was once I got my results. Average for the month was 1.78 KT/V

Mine was 1.5 and they said it should be 1.8, come on, whats .3 measly little numbers, well, now, they have me on the cycler 11 hours and now i have to have 3000 ml dwelling in me 5 times with one manual drain... crazy huh?

I remember when I was on PD they were telling me that my clearance was barely enough. It seems I do better on Hemo even though I LOVED PD a LOT more

[Zach]

I would be interested to hear what everyone's URR is.  This month mine was 75.  In the past it has been 70.

[babi68]

Did my URR the other week. Twice actually. On the "normal" dialysis machine I got 78. Then I tested again when I did the HDF machine and the result was 81. Pretty happy with that. So 5 hours, 3 times a week is working for me. My doctor said to leave it at 5 hours so I do. Liz

[Panda_9]

URR is about 90%

[Joe Paul]

My average urr since starting dialysis in April has been 72.

[AlasdairUK]

My URR is 85% on 4hrs 3 x a week. Running at 400 pump speed. I'm happy with that. I do feel a lot better if I go over 85 litres. It seems to be a cut off point for me. Has anyone also noticed a point where they feel a lot better?

[Zach]

My URR is 85% on 4hrs 3 x a week. Running at 400 pump speed. I'm happy with that. I do feel a lot better if I go over 85 litres. It seems to be a cut off point for me. Has anyone also noticed a point where they feel a lot better?

What do you mean by "if I go over 85 litres"?

[Bajanne]

I didn't even know about Kt/V, and when you guys started a thread about it, I had to be silent.  It is coincidental, but my nurse last Friday told me what mine was.  I was telling him that you guys were talking about it and I had no idea.  Mine was 1.3