KT/V
The measurement that they use to determine how well a person is being dialyzed is KT/v. It seems quite limited to me, because it only uses one actual measurement (urea clearance) multiplied by time and divided by the volume of total body water. I just read an article from "Dialysis & Transplantation" magazine which points out that some waste molecules are larger than Urea and some are smaller (meaning a filter optimized for urea might not eliminate larger molecules very well).
They looked at KT/v versus mortality and found that people with higher kt/v lived longer. Is that enough? Rod Kenley of Aksys lists 16 criteria to determine how well someone is being dialyzed.
- Normalized Blood Pressure with minimal antihypertensive medications
- Normalized Calcium-phosphate product without binders
- Absence of intradialytic symptoms (hypotension, cramps, nausea)
- Absence of Interdialytic symptoms
- No interference with job
- Protein apetite
- Neither alkalotic or acidotic
- No evidence of LVH (a heart problem)
- Hematocrit within 35 to 38 with 50% or less of average EPO dose.
- No dialysis or access related hospitalizations
- Normal Triglyceride levels
- No evidence of Amloidosis
- Longest preservation of residual kidney function
- life expectancy approximately that of living related donor transplants
- Inflammation near normal
- global cost to treat no more that $45,000 per year.
That makes a lot of sense to me. Increasing my time on the machine IN-CENTER increased my KT/v (meaning I am healthier), but made my inter and intra- dialitic symptoms got worse. HOME Hemo has increased my KT/V and has already lowered my needs for Antihypertensive medications, my protein appetite has increased, and my inter and intradialytic symptoms have been reduced. By all measures, that means home hemo is better for me than in-center, but that doesn't get reflected in Kt/v.
Just wanted to send out a big "Get Well Soon" to Rich Bobbe. He recently had a heart attack and he's back home. Our thoughts and prayers are with the whole Bobbe family.
