Instructions for using Hemodialysis Adequacy Calculator

by Robert S. Gillespie, MD, MPH

 

To determine Kt/V as actually delivered:

 

1.  Use the left half of the sheet.

 

2.  Enter the information requested in the yellow boxes (date, pre/post BUN, session length, post-dialysis weight and net ultrafiltrate.)  Note that in the “session length” boxes you can enter the session length in any combination you like.  For example, for a 3.5 hour session the following are all equivalent and you could use any of them. 

 

3

hours

3.5

hours

 

hours

2

hours

30

minutes

 

minutes

210

minutes

90

minutes

 

It would be a little odd to use the 2 hours/90 minutes format, though.

 

3.  After you have entered the last piece of data, be sure to hit return or move your cursor to another box so the sheet will recalculate.

 

4.  Now just read your URR and spKt/V off the sheet.  Note that the background is green if it meets K/DOQI guidelines, and red if it doesn’t.

 

To determine the prescribed or predicted Kt/V:

 

1.  Use the right half of the sheet.

 

2.  You can enter the dialyzer name and desired blood flow rate if you like, but this is just for your own reference.  The computer will not take these into account.

 

3.  Enter the Curea for the dialyzer you have chosen, at the blood flow rate you have chosen.  You can get this from the manufacturer’s literature.

 

4.  Enter the session length desired.  Note that in the “session length” boxes you can enter the session length in any combination you like.  For example, for a 3.5 hour session the following are all equivalent and you could use any of them. 

 

3

hours

3.5

hours

 

hours

2

hours

30

minutes

 

minutes

210

minutes

90

minutes

 

It would be a little odd to use the 2 hours/90 minutes format, though.

 

5.  Enter the patient’s dry weight in kg.

 

6.  Enter the desired Kt/V (this step is optional).

 

7.  After you have entered the last piece of data, be sure to hit return or move your cursor to another box so the sheet will recalculate.

 

8.  Now just read your URR and spKt/V off the sheet.  Note that the background is green if it meets K/DOQI guidelines, and red if it doesn’t.

 

9.  If you entered a desired Kt/V, the sheet will also display the predicted number of minutes needed to reach that Kt/V.

 

10.  If you want to tweak the prescription, just change any of the values to see what Kt/V you will get.

 

11.  The “Notes” and “Interpretation and Plan” section are yours to enter typed or handwritten comments.

 

Here’s Another Way to Do It:

 

The author highly recommends the online “kt-v.net” by Asher Schachter at http://www.kt-v.net .  This sophisticated, free online tool works for hemodialysis and peritoneal dialysis; calculates nPCR; and does not require you to look up the Curea.

 

Fun Things for Advanced Users

 

Add your own logo:  Remove the seesaw logo at the bottom left, then paste in your logo.  Type in the name of your practice or hospital.

 

Create a macro to sign your reports:  Write your signature on a piece of paper and scan it.  Crop and save the file to your hard drive as a jpeg or gif file.  Now select Tools—Macro—Record New Macro.  In the box which pops up, type in a name such as “Signature.”  Select a shortcut key such as Control-S.  After you click OK, the box disappears.  You are now recording.  Select Insert—Picture—From File…  Now select that signature file.  Move it to the desired location at the  bottom of the “Notes” section and then click on the stop recording button (that little button with a square on it.)  Save the document.  Now any time you want to add your signature just type control-S.

 

How Does it Work?

 

This spreadsheet uses the Daguirdas II formula.   The rest is all just a matter of manipulating the formatting, conditional formatting and graphing features of Excel.