When Kt/V drops:

• 40% of the cases occur due to decreased dialysis time or inadequate dialyzer blood flow (Qb)
• 25% of cases are due to significant access recirculation

Troubleshooting:

• Repeat measurement to confirm the drop using standardized measurement technique as described in the video “How to measure Kt/V in the HD unit”
• Confirm accuracy of post BUN measurement
• Confirm adequate Qb and time on dialysis
• Check access integrity
• Optimize Qb and Treatment time, resolve access issues
• Use a higher efficiency dialyzer (higher KoA)
• Can increase dialysate flow (Qd) although gain above 800ml/min is minimal