Troubleshooting Low Kt/V

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


  • 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