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Calculate Kt/V and URR to assess hemodialysis adequacy
Longer sessions improve clearance. Consider extended or nocturnal dialysis.
Higher Qb (blood pump speed) increases clearance. Target 400-500 mL/min if tolerated.
High-flux dialyzers with larger surface area improve Kt/V.
Recirculation reduces effective clearance. Monitor access function regularly.
How efficiently the dialyzer removes urea (mL/min)
Duration of dialysis session (minutes)
Total body water (approximately 60% of body weight)
Accounts for urea generation and ultrafiltration. More accurate than single-pool Kt/V.
URR is simpler (% BUN reduction) but does not account for ultrafiltration or urea generation. Kt/V is more comprehensive and is the preferred measure.
Monthly per KDOQI guidelines. More frequently if inadequate or after prescription changes.
No clear upper limit for harm, but extremely high Kt/V may indicate muscle wasting or low protein intake rather than excellent dialysis.
Access recirculation, shortened treatments, needle placement, patient size, and blood flow rate all affect delivered Kt/V.
In PD especially, residual kidney function contributes to total clearance. As RKF declines, PD prescription may need to increase.
Single-pool assumes urea is evenly distributed. Equilibrated (eKt/V) accounts for post-dialysis urea rebound, giving a more accurate measure of actual clearance.
Adequacy is just one measure of dialysis quality. Clinical symptoms, volume status, phosphorus/PTH control, anemia management, and nutritional status are equally important.