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Author Topic: Kt/v nightmare  (Read 2656 times)
Tío Riñon
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« on: December 09, 2016, 05:21:35 AM »

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.
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Michael Murphy
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« Reply #1 on: December 09, 2016, 06:06:21 AM »

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.
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Shaks24
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« Reply #2 on: December 09, 2016, 08:54:11 AM »

***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?

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Congestive heart failure 2011
Currently about 19% Kidney Function
September 11, 2013 PD Catheter and Fistula Surgery
September 27, 2013 Started PD
Tío Riñon
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« Reply #3 on: December 09, 2016, 10:26:10 AM »

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.
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kickingandscreaming
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« Reply #4 on: December 09, 2016, 11:23:55 AM »

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
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solid98
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« Reply #5 on: December 09, 2016, 01:03:01 PM »

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.
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kitkatz
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« Reply #6 on: December 13, 2016, 05:17:47 PM »

Fresenius wants a KT/V of 1.4  for hemodialysis patients.
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Simon Dog
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« Reply #7 on: December 13, 2016, 07:01:47 PM »

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.
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cassandra
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When all else fails run in circles, shout loudly

« Reply #8 on: December 13, 2016, 10:07:05 PM »

Huh Kt/v is 1.2
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I started out with nothing and I still have most of it left

1983 high proteinloss in urine, chemo, stroke,coma, dialysis
1984 double nephrectomy
1985 transplant from dad
1998 lost dads kidney, start PD
2003 peritineum burst, back to hemo
2012 start Nxstage home hemo
       still on waitinglist, still ok I think
Vt Big Rig
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« Reply #9 on: December 15, 2016, 07:55:14 AM »

WHAT,  I'm doing home hemo and have to meet 2.0!!
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VT Big Rig
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God Bless my wife and care partner for her help
cassandra
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When all else fails run in circles, shout loudly

« Reply #10 on: December 15, 2016, 01:38:53 PM »

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.
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I started out with nothing and I still have most of it left

1983 high proteinloss in urine, chemo, stroke,coma, dialysis
1984 double nephrectomy
1985 transplant from dad
1998 lost dads kidney, start PD
2003 peritineum burst, back to hemo
2012 start Nxstage home hemo
       still on waitinglist, still ok I think
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