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Am I better off if my delivered KT/V is over 1.2?
An important question which has been debated for years. DOQI closely examines this issue and concludes that at this time the current research does NOT support any benefit to the patient if they have a KT/V of greater than 1.2.
If I am diabetic, should I have a different KT/V?
The answer is NO. While there is some research which suggests this, DOQI feels the data is not conclusive. The same is true for different races, the minimum delivered dose is 1.2 KT/V for all patients.
How often should the KT/V measurement be done?
DOQI (Guideline#6) suggests monthly. The main reason for this is that many patients do NOT receive a 1.2 KT/V every time due to problems such as patients starting treatments late, early termination of treatments, poor blood flows, etc. Deficiencies in treatment must be detected as soon as possible so they can be corrected, and the frequent KT/V measurement will help quickly detect problems.
Does it matter how my blood is drawn when my dialysis adequacy is measured?
Yes!!! DOQI (Guideline#8) says this is very important, since using different methods can change the results. At least two samples are required and both are from the Arterial blood tubing. One is before dialysis is started, and before any heparin or saline are given. This is called the PreDialysis sample. After dialysis is over, the PostDialysis sample is taken. The details of how the PostDialysis sample is obtained is very important and is explained in detail in the Rationale. One of the most important aspects of this is drawing the PostDialysis sample within 30 seconds after completion of dialysis and before any saline is given to flush the lines. If you see that your PostDialysis sample is taken more than 30 seconds after dialysis completion, or saline is administered immediately prior to your sample being obtained, the sample is has been incorrectly taken and should not be used. You need to bring this to the attention of the nurse incharge of your treatment. Use of incorrectly obtained samples invalidates the KT/V for the treatment and should not be used.
What if the dialysis adequacy method used by my unit is not the KT/V method recommended by the DOQI Guidelines and they tell me it is just as good?
DOQI (Guideline #2) clearly states that the Gotch/Sargent method is the BEST METHOD for determining dialysis adequacy. The Rationale goes into a detail explanation of why this is the method of choice, and the different problems with all the other available methods. DOQI indicates that there can be a significant difference between the KT/V obtained using the Gotch/Sargent method and other methods. However, DOQI does recognize that not all units may use the Gotch/Sargent method due to the need for a computer to perform the calculations or for other reasons. In this case, the alternate KT/V calculation method suggested is one called the Natural Logarithm Formula. The only other method which should be used in adults is the URR (Urea Reduction Ratio). This does NOT mean that DOQI is recommending these other two methods. What the Rationale says is that these are less satisfactory methods which should be use ONLY if the Gotch/Sargent method can not be used. In the Rationale (AJKD, Vol. 30, Sept 97, p S28) the quality of the URR is described by " .. its relative inaccuracy and the incompleteness of the information it provides compromise its use as the sole measure of delivered dialysis doses in individual ESRD patients."
In summary, the DOQI Guidelines provide the patient with optimal goals they should strive for and one of these areas addressed is Dialysis Adequacy. DOQI Guidelines
indicate you should have a KT/V done monthly using the Gotch/Sargent method and this should be a minimum of 1.2 delivered. For those interested in learning more about the DOQI guidelines, the Executive Summary is an excellent place to start. This is available from the NKF (800-622-9010) and is also on their web site: www.kidney.org
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