Kt/V

[Jess21]

Does anyone know what Kt/V has to be to lower the time on dialysis?  I had my time dropped once, but I can't remember what it had to be.  My kT/V is 1.75somethingorother, it went up in the last month, versus my access flow rate going down 200.  Am I right in it having to be 1.85? or was it 1.65?  Sigh..I can't remember..  
Lower time= possiblilty of going back to my main center before I get done with school..plus more time in my life...

[Wattle]

I am on PD and I know they "like" my Kt/V to be above 2. It was 2.07 at my last PET test in October.

[kitkatz]

My last KT/V on Nocturnal was 3.1. A big change from 1.5 on conventional dialysis!

[Zach]

My last KT/V on Nocturnal was 3.1. A big change from 1.5 on conventional dialysis!

Fantastic!
 

[Rerun]

My last KT/V on Nocturnal was 3.1. A big change from 1.5 on conventional dialysis!

Mine was 2.9. 

My Potassium was 5.0 and my Phos was 3.3.  That calls for a glass of MILK!     

[Zach]

Mine was 2.9. 

My Potassium was 5.0 and my Phos was 3.3.  That calls for a glass of MILK!     

  (Milk)

[Wattle]

wooohooo Kit and Rerun that is Fantastic!!

I wonder if mine number here is the same as there? I know everything else is measured differently. 

[RichardMEL]

Yes Wattle the Kt/V is the same measurement here. My last measure was around 1.5

[qwerty]

KDOQI guidelines state kt/v of 1.2 with a urr of 63. Most companies require a KT/V of at least 1.45 with a URR of 65. My company uses the 1.45. They also recommend that no one should run less than 3 hours time. Even if the KT/V is higher than the 1.45 we still dont run less than 3 hours (in center hemo) at least in my clinic we dont.

[Wattle]

Yes Wattle the Kt/V is the same measurement here. My last measure was around 1.5

Can you dialyze longer Rich? I have been told if I drop under 2 I will have to stay on longer at night or do another day exchange.

[RichardMEL]

Yes Wattle the Kt/V is the same measurement here. My last measure was around 1.5

Can you dialyze longer Rich? I have been told if I drop under 2 I will have to stay on longer at night or do another day exchange.

frack that! I'm already doing 5 hours in-center which is the most they do on a regular basis. I run at pump speed 350 (again the top they will do here, they don't believe in higher pump speeds for stress on the fistula/body). Besides my URR has chopped & changed between 74% & 82% which is pretty good and we all know the URR is a better indicator than Kt/V.

Out of interest I got the machine to do Kt/V on my last session on Tuesday and it came back about 1.45 by the end. *shrug* The staff weren't concerned.

Wattle because you do home/nocturnal your kt/V will be larger and I think the "rules" are very different.

[Wattle]

Wattle because you do home/nocturnal your kt/V will be larger and I think the "rules" are very different.

Your probably right. The "rules" may also differ between Haemo and PD. Having not been on PD I cannot compare. I was just told I would feel like crap under 2 but I feel like crap most of the time anyway.

5 hours geez I wish they would bring in Nocturnal incenter Rich. That would make the long hours a little less taxing. I do 8 hrs but at least I am asleep. (when i can sleep    )     

[kidney4traci]

I think it is different for Home Hemo Nxstage too.  They want mine over 2, and it was last time, but they increased my pump speed to 420 to get it there.  I t kept hovering around 1.8, 1.9 on 400.  But I remeber my dr saying it was calculated differently for me now that I am on home hemo.  Wow, RM, you can't go over 350??  Maybe if you could, you could do less time??  Just curious, bless you as  that is a long time!!  I knew you were Superman!!! 

[paul.karen]

Wow i have still so much to learn.
I have no idea what any of this means.
All in due time.

Rich when i start dialysis and get Cranky or pissy i will just have to think of you.
You seem to stay so level headed laid back and just Peepy.  I have never had a role model but im thinking you may be it.

Hope that doesnt creep you out .
I just admire your spirit. 
P&K

[Zach]

Wow, RM, you can't go over 350??  Maybe if you could, you could do less time??  Just curious, bless you as  that is a long time!!

Studies are showing that time is perhaps the most important factor in optimal hemodialysis.  Kt/V is only based on small molecule removal (Urea). There are larger "middle molecules" which take longer time to remove from the body, such as phosphorus and ß2-microglobulin.

So, if a high Kt/V is achieved by means of a fast blood pump speed and less time dialyzing, removal of these "time dependent" toxins will be reduced.

Not good.

[Wallyz]

I run overnight 7 days a week, and My Kt/V was 3.2.  No binders, normal diet, great labs.

Run longer and slower people.  Nocturnal, Nocturnal Nocturnal.  Dialysis is not your problem, being underdialyzed is the problem.

[charee]

I'm with you Wallyz, the longer the better when i was on dialysis i was doing 8 hours every second day , no binders normal diet great labs off blood pressure meds.  5 hours 3 x week is not enough but  its all the govt will fund , but i understand not everyone can do home dialysis and they have to do what they can.

[Zach]

I run overnight 7 days a week, and My Kt/V was 3.2.  No binders, normal diet, great labs.

Run longer and slower people.  Nocturnal, Nocturnal Nocturnal.  Dialysis is not your problem, being underdialyzed is the problem.

The Gold Standard of hemodialysis.

[kidney4traci]

yes, I get it, but I do have good labs at home now doing 2.25 hours 5x/wk.  They increased my pump speed slightly, but had already increase the dialysate # from 16 to 17 units which did increase time too.  SO with both, it is a good reading now.  I think that's ok???

[nursewratchet]

1.4 is a good measure for KT\V.. More is better of course.  If you are concerned with a shorter time, you could also ask about a larger dialyzer, which will filter better.  Next is a larger size needle (ouch), and then a higher blood flow.  Those will increase KT\V, while keeping, or shortening the time.  Nocturnal or Frequent Home Hemo is best, but not always an option. 

[RichardMEL]

I'll try and answer a few posts here.

First of all being a "role model" is kind of weird yes... but if it's karen who is saying that I can handle that more, because if a woman looks up to me in some way that's a rare thing indeed, so I'll treasure that!!! If it's Paul.. well umm yeah what the heck... !!  I don't think I'm really a role model. I just try to make the best of a difficult situation and I figure curling up in a corner and being depressed doesn't help anyone - least of all me. So yeah.. we do what we can.

As for why we don't go over 350 and doing 5 hours and wanting less etc. Sometimes I see other patients doing 4.5 or 4 hours and I wonder.. but they also weigh much less than me, or are sicker.. I am also aware that more dialysis is a GOOD thing and in the end will probably be better for me in terms of living, and keeping my body as prime as it is able to accept a transplant if/when that comes. Sometimes it's a real hassle though 5 hours is such a drag, specially because I just can't sleep in those chairs no matter how comfortable they claim to me! LOL.

I would love to do nocturnal at my unit and have mentioned it to the powers that be. They did say that a new boss was coming in who may want to look at it (but I'm not getting my hopes up!). A regional city here (Geelong) does it in their unit and have been quite successful, so that may push it along. If I could get a bed (even on a trolley) and hooked up I reckon I could sleep. Turn out most of the lighs etc yeah.. that would be great.

I think I wrote earlier that also we treat Kt/V as not as good a measure as the URR and my URR clearance is decent at 74% and was fantastic at 82% (just have to figure out why it went down ) so yeah.. all in all I'm fairly happy with where I am at. All the labs are in the good range - specially K, Ca (finally!) and Phosphate which I'm REALLY happy with.

So just plug on being a role model I guess!!! 

[Wallyz]

1.4 isn't  a good number, it's  a minimally acceptable number. Keeping people at 1.4 requires  a ridiculously restrictive diet and on binders that cause some people to vomit and be unable to keep food down.  Short dialysis does not significant ly remove phosphorus from the system.  You need to start thinking about optimal dialysis, not minimally acceptable dialysis.

[pelagia]

I found this link about Kt/V and URR. 

http://kidney.niddk.nih.gov/Kudiseases/pubs/hemodialysisdose/

[Wallyz]

These numbers—a URR of 65 percent and a Kt/V of 1.2—have been determined to be benchmarks of dialysis adequacy on the basis of studies in large groups of patients. These studies generally showed that patients with lower Kt/V and/or URR numbers had more health problems and a greater risk of death. However, the HEMO clinical trial (see Hope through Research) showed that a Kt/V greater than 1.2 did not result in improved outcomes.

This is a load of crapola.  Perhaps not in mortality outcomes, but certainly in quality of life outcomes.  Look at the NxStage clinicals if you want  abetter picture of At home daily vs in center.

[Zach]

I found this link about Kt/V and URR. 

http://kidney.niddk.nih.gov/Kudiseases/pubs/hemodialysisdose/

Unfortunately, that information (2005) is considered by many folks out-of-date.

The HEMO study, which is the basis of the article, is seen as flawed--because it didn't consider increased time (8 hours vs. 3-4 hours.) as a factor for improved outcomes (and in the process increased Kt/V).

In the case of the HEMO Study, there was a high-dose group, with a target Kt/V of 1.65, and a standard-dose group, with a target Kt/V 1.25, both using either a low-flux or high-flux dialyzer.  The conclusion was that a Kt/V greater than 1.2 did not result in improved outcomes.

If the study had considered increased time (8 hours vs. 3-4 hours 3 x week), the greater Kt/V achieved would also have reflected the greater removal of the "middle molecules" and would have resulted in a conclusion that it did improve outcomes.

A more recent study from Turkey on in-center nocturnal hemodiaysis concludes:
   "For hemodialysis patients, undergoing dialysis for eight hours overnight, three times weekly, reduces the risk of death by nearly 80 percent, compared to conventional, four-hour dialysis."

Now that's a study you can believe in.



You can read more about the study in this IHD post:
http://ihatedialysis.com/forum/index.php?topic=11085.0