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Monthly kt/v significantly lower than tx day spkt/v


HD folks,

I want to understand clearance better.

I have a patient who always clears >2.0 on the machine for every tx, but when we draw monthly labs, he always come is below 1.2.

Very compliant (phos, ca, fluid gains etc show compliance), never misses tx. Has a fistula >2yrs.

Ps, we have tried different machines so we know it's not a machine error, and different people draw his labs so it's not user error.

What could the cause be?

Still new to HD, so I hope the question makes sense


Has the access RN seen him. Could be recirculation in the access. What machine do you use and what blood flow do you usually run at?

We have the Dialog + now and the kt/v seem to be fairly accurate and more reflective of the blood work (I think). We previously had the Phoenix and sometimes the ktv would skyrocket but be crappy in the bloodwork if there was clotting in the dialyzer. Maybe more anticoagulant needed?