KT/V

What is the goal Kt/V?

  • This applies to conventional intermittent 3 times a week hemodialysis
    • Per KDOQI 2006 guidelines:  For patients with minimal residual renal function (<2ml/min per 1.73m2)
      • Minimally adequate dose should be a spKt/V of 1.2
      • Target recommended dose should be a spKt/V of 1.4 (or eKT/V of 1.2)
  • There is a lack of randomized studies to support the minimum dialysis dose of spKt/V ≥1.2.
  • However, retrospective studies suggest that a Kt/V <1.0 is associated with poor outcomes and that a Kt/V ≥1.2 is associated with better survival123.
  • The HEMO study4 showed that targeting a spKt/V higher than 1.4 did not improve survival or reduce hospitalization rates over 2.8 years.
CLINICAL PEARLS:

  • Based on large retrospective studies, a Kt/V <1.0 is associated with poor outcomes. Clinical practice guidelines, therefore, recommend a minimum delivered spKt/V of 1.2.
  • Delivered Kt/V is often lower than the prescribed Kt/V. This could be related to multiple reasons such as interrupted treatment due to machine alarms, access recirculation, blood or dialysate pump calibration errors that leads to decreased delivered Qb or Qd etc.
  • Therefore, to achieve a delivered spKt/V of 1.2, a target spKt/V of 1.4 is recommended. This equates to an eKt/V of 1.2

Sources:

  1. Owen WF Jr, Lew NL, Liu Y, et al. The urea reduction ratio and serum albumin concentration as predictors of mortality in patients undergoing hemodialysis. N Engl J Med. 1993;329(14):1001.
  2. Gotch FA, Levin NW, Port FK et al. Clinical outcome relative to the dose of dialysis is not what you think: the fallacy of the mean. Am J Kidney Dis. 1997;30(1):1.
  3. Held PJ, Port FK, Wolfe RA et al. The dose of hemodialysis and patient mortality. Kidney Int. 1996;50(2):550.
  4. Eknoyan G, Beck, GJ Cheung AK, et al. Effect of dialysis dose and membrane flux in maintenance hemodialysis. N Engl J Med 2002; 347:2010. Hemodialysis study (HEMO)