Getting Adequate Dialysis

Healthy kidneys work 24 hours a day, 7 days a week, doing some of the most important tasks in the body. When kidneys stop working efficiently, dialysis is carried out to mimic the organ’s roles. Adequate dialysis means enough treatment to help you live long and well even with kidney disease.

Kidney dialysis is measured in doses, just like how medicines are measured. Your doctor will prescribe a dose of dialysis that should keep you feeling well. Your urea reduction ratio (URR) or Kt/V score will tell you if you are getting enough treatment.


Haemodialysis removes many wastes. One of these waste products called urea or blood urea nitrogen (BUN) is used to measure dialysis adequacy. BUN can be tested before and after dialysis to see how much waste has been removed. The test to compare BUN levels before and after dialysis is what we call URR.

URR should be 65% or higher to ensure that you are getting enough dialysis. Your doctor should prescribe a URR of 70% or higher to make sure that your URR is at least 65%.


Kt/V is another way to measure the dose of kidney dialysis.

  • “K” – measures clearance (urea and other waste removal) of the dialyzer
  • “T” – time (how long each treatment lasts)
  • “V” – the volume of fluid in your body

Your Kt/V should be 1.2 or higher to ensure that you are getting enough dialysis. Your doctor should prescribe a Kt/V of at least 1.4 to make sure that your Kt/V is at least 1.2.

Why is it important to get enough haemodialysis?

Kidney dialysis is not a one-size-fits-all kind of therapy. Each patient has a different requirement that should be met in order for it to be optimal.  Not getting adequate dialysis may result to the following:

  • You will feel ill.
  • Your skin may turn yellow.
  • You may experience itching.
  • Your feet may swell up with fluid.
  • You may not want to eat.
  • It may be hard for you to sleep.
  • You may feel fatigued or experience shortness of breath.
  • You may feel depressed.
  • Your thinking may be slower.

Over time, if you do not get enough dialysis, you increase your risk of death. Getting enough dialysis will help you live long and well. You can get too little dialysis, but never too much.

Make time for each haemodialysis treatment

Time is the part of dialysis that you have the most control over.

Why does each minute of kidney dialysis count? There are 168 hours in a week and you will spend around 12 hours for your dialysis treatment. Missing as little as 2 minutes of each session will already add up to more than 5 hours of dialysis missed in a year.

Tips to ensure that you get all your haemodialysis time

  • Always be on time for your treatment.
  • Avoid large water gains that can cause painful cramps and make you stop your treatment early.
  • Stay until the end of each treatment.
  • Make sure that you get to make up all the minutes lost due to machine alarms, machine breakdown, or bathroom trips.
  • Consider changing to daily, nocturnal or home dialysis
  • Don’t allow your time be cut short if your treatment starts late, staff wants to leave, or it’s a holiday.

To summarize these all, the two methods generally used to assess kidney dialysis adequacy are URR and Kt/V.

  • A patient’s average URR should exceed 70%.
  • A patient’s average Kt/V should be at least 1.4.

A patient’s URR and Kt/V can be increased through the following:

  • Increasing time on dialysis.
  • Increasing blood flow through the dialysis.
  • Increasing the size of dialyzer.

Also, it is not true that getting good URR and Kt/V numbers will allow you to cut back on your haemodialysis time. Removing enough phosphorus and Β²m (protein that causes amyloidosis) takes time. Therefore, you need each minute of dialysis that you can get. You may feel an immediate effect when you have too much or too little water removed, but it can take years to feel the ill effect of not having enough wastes removed.

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