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Kt/V and URR The Kt/V and Urea reduction ratio URR are 2 important numbers that your health care team uses to measure how well your blood is being cleansed of urea. A low Kt/V or low URR means that you are not getting adequate dialysis. This could reduce your quality of life. You should strive to keep your Kt/V and URR as high as possible by staying for your full treatment time and by never skipping dialysis. The National Kidney Foundation recommends: Goal Kt/V for hemodialysis: at least 1.2 or greater. Goal URR for hemodialysis: at least 65% or greater.
Blood pressure (Hypertension) Your blood pressure numbers reflect the force of the blood in your blood vessels. When your blood pressure is high, your heart has to work harder to pump blood around your body. This can also make your blood vessels get harder (hardening of the arteries also known as artiosclerosis) and narrower. The top number is called the systolic blood pressure and reflects the pressure as your heart beats to pump blood out of the heart into circulation. The bottom number is called the diastolic number and reflects the pressure in your blood vessels when the heart is relaxed. Hypertension can damage all of the vital organs in your body. Hypertension is a leading cause of congestive heart failure and kidney failure and stroke. Goal blood pressure before dialysis: below 140/90. Goal blood pressure after dialysis: below 130/80.
Hemoglobin (HgB) and Hematocrit (HcT) The hemoglobin molecule is inside of your red blood cells and carries oxygen around your body. Measuring your hemoglobin tells your health care team how much oxygen carrying blood is in your circulation. The hematocrit measure how many red blood cells that your bone marrow is making. Keeping your hemoglobin and hematocrit in goal range will ensure that your have enough blood to prevent anemia and therefore weakness and lack of energy. The National Kidney Foundation recommends keeping hemoglobin between 11.0 and 12.5 grams per deciliter. This is accomplished by making sure that you receive erythropoietin or Aranesp and have plenty of iron in your bone marrow.
TSAT and serum ferritin Your TSAT is your transferrin saturation and reflects how much transferrin is saturated with iron. These tests tell your health care team if your bone marrow has enough iron to make blood. The National Kidney Foundation Recommends: TSAT for patients on hemodialysis and peritoneal dialysis: greater than 20%. Ferritin for patients on hemodialysis: greater than 200 Ng/ml. Ferritin for patients on peritoneal dialysis: greater than 100 ng/ml.
Parathyroid Hormone (PTH) Parathyroid hormone is made by four glands on the back of the thyroid glands in the neck. Parathyroid hormone signals the body to make sure that there is enough calcium and phosphorous in the blood stream. Because of your kidney disease, your parathyroid glands may secrete to much PTH. Too high of a PTH can lead to bone weakness, intense itch, muscle weakness and heart disease. The National Kidney Foundation recommends: Goal range for iPTH : 150-300 pg/ml. Goal range for biPTH: 75-150 pg/ml.
Serum Calcium Calcium is a mineral in your blood stream that helps to keep bones healthy and helps your muscles and nerves work correctly. In the body most of your calcium is stored in bones and teeth with a small amount in your blood. Calcium is absorbed from the food that you eat by activated vitamin D3. Too much calcium in the blood (Hypercalcemia) can cause stomach irritation, confusion and irritability. The National Kidney Foundation recommends: Goal for calcium level on dialysis: 8.4 mg/dl to 9.5 mg/dl.
Serum Phosphorous Phosphorous is a mineral that is found in your bones and blood stream. Phosphorous is absorbed from the food that you eat and along with calcium it helps to keep bones strong and healthy. Your kidney disease may lead to having too much phosphorous in your blood (hyperphosphatemia) that can lead to intense itch, bone damage, pain and calcium-phosphate deposits in your skin and other organs. The National Kidney Foundation recommends: Goal range for phosphorous for patients on dialysis: 3.5 to 5.5 mg/dl. Avoiding milk and dairy products and taking your phosphate binders regularly will help keep your phosphorous in goal range. THIS IS VERY IMPORTANT. You should also strive to keep your calcium-phosphorous product (Ca X P) under control. The National Kidney Foundation recommends: Goal Calcium-phosphorous product: less than 55 mg/dl.
Total Cholesterol Cholesterol is a fat like substance found in your blood. There are many types of cholesterol. LDL cholesterol (lethal cholesterol) can clog your blood vessels and lead to hardening of the aterties. HDL cholesterol (Healthy cholesterol) helps to get rid of bad cholesterol and can help protect the blood vessels and heart. The National Kidney Foundation recommends: Total cholesterol: under 200 mg/dl. HDL cholesterol is also called high density lipoprotein (I call it healthy density lipoprotein) removes deposits from the inside of your blood vessels helping to keep them clean and unclogged. The National Cholesterol Education Program recommends: Goal HDL cholesterol: above 40 mg/dl. LDL cholesterol is also called low density lipoprotein (I call it lethal density lipoprotein). LDL can coat blood vessels making them hard and narrow so that they carry less blood. The National Cholesterol Education Program recommends: Goal LDL cholesterol: below 100 mg/dl.
Blood Glucose (Blood sugar) Elevation of blood glucose occurs in patients with diabetes. Most diabetics measure their glucose 1-4 times per day or more. A good test that averages your glucose reading over about 90 days is the Hgb A1C test. The American Diabetic Association recommends: Goal HgB A1C: less than 7%.
Serum Albumin Serum albumin is a protein that is made by your liver and found in your blood. Albumin carries hormones, minerals and other important things in our blood around your circulation. A low albumin reflects poor nutrition and suggests that you need to eat more. The National Kidney Foundation recommends: Goal albumin: 4.0 g/dl or more.
Potassium Potassium is a mineral found in your blood that help regulate your heart beat and helps all muscle cells work properly. A potassium level that is too high or too low can cause extra heart beats and weak muscles. The National Kidney Foundation recommends: Goal potassium: 3.5 to 5.0 mg/dl.
For additional information please talk to your dietician or other health care providers or return to the kidney education page and click on other hyperlinks.
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