This is for those of you who were on PD, and were on it until it stopped working (not because you got a transplant):
So how did you "know" when PD stopped working? Did you wake up one morning and the cycler said "not today, we're done here"? Or did you know by the lab tests? Or did you know by how you felt and by symptoms (swelling, nausea, etc). And what was the experience like. Did it slowly decline over weeks or months or did it decline over days? Did you increase solution strength toward the end to compensate for reduced effectiveness or longer dwell time? Did you get really sick? Was it gosh awful, or just sorta awful?
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RonZone
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Your Kt/V values determines how well your dialysis is working. It measures the waste products in your urine and dialysis drainage. It also measures protein nutrition and is able to assess how well you are eating. If your values show you're not clearing toxins sufficiently, then your nephrologist will likely increase the length of time you're on the cycler, change the dialysate strength, or have you carry some dialysate during the day. My hubby's PD nightly sessions increased over time and he was also asked to carry some additional dialysate through the day. We were getting a little concerned about the direction of all of this, but then a transplant come through for him. As the clearance worsens, many begin to feel like they're in kidney failure again....but a switch to hemodialysis makes them feel a lot better. (In my hubby's case, he began to complain of feeling more tired and less energetic; he was spending around 10 hours a night on the cycler and so on.) Labs for PD likely will be taken once a month...we were asked to bring in a sample of waste (generally the whole bag) for them to check. If you're asked to bring in the entire bag, I'd recommend plopping it into something like a wheeled laptop or book bag carrier so you can wrangle your way through doors easily, etc. You'll find that, whether you're on HD or PD, Kt/V will always be of significant interest.
Kt/V sadly is still used as indication of quality of dialysis even though by most kidney communities its considered an antiquated, outdated measurement and no replacement exists. I couldn't produce any urine for testing so mine were all blood tests. I personally had twitching increased, including lips (often low calcium symptoms), lack of appetite, nausea, vomiting, extreme fatigue, weakness, foggy headed increase. Drain bags never tested. As soon as my symptoms increased I took myself to hospital, from there admitted. In 20+ years of dialysis each time I've gone to ER I've been admitted except 1-3 times. I'm very self aware and in tune and self advocate. Most ER docs will tell me I know more about my disease and treatment than they do. Educating yourself is empowering. Blessings
Yes! Discounting or short schrifting patients seems to be acceptable here and there. (I'm shocked that your drain bags weren't checked and analyzed in that regard!) Truly, a lot more needs to be done to move the field forward - honestly, an implantable mechanical kidney should be here now for everyone. But that's all tied up in red tape. Glad you're self-advocating for yourself. I worry about those that don't do that.
What does KT/v stand for? I just did a 24 hr urine collection and took it to the center where they did a blood draw while I was there, but that's the night my first cycler died so I couldn't get the sample from the drain bag to take in. Not sure if they will be able to use the 24 hour collection without the drain bag sample. I've not talked to my PD nurse since I took in that 24 hr collection.
The Kt/V is a dimensionless ratio representing the fractional urea clearance. K is the dialyzer blood water urea clearance (mL/minute or L/hour), t is the dialysis treatment length (minutes or hours), and V is the distribution volume of urea (mL or L)
urea reduction is one of the easiest blood components to measure. It is a mathematical equation measuring urea and time by volume removed. That is what I can remember. i used to have it down pat but over the years its been a consensus as an antiquated and fairly useless measurement even though it is still used as an adequacy of treatment.
Hey, thanks for this explanation. It gives me something to ask my PD nurse about as to how they figure out how effective my dialysis is. I'm currently doing 8.5 hours each night with 5 exchanges 7 nights a week using 1.5% solution strength (tried 2.5 but it gave me cramps, so she backed it back off to 1.5%)
Lol, your nurse will definitely let you what she wants next time. In my hubby's case, both were required monthly - drain bag and urine test - in evaluating outcomes.
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