3) Raccoons & The Urea Reduction Report

Tuesday

It's been a very good two days since my dialysis on Saturday. I've been feeling great and its a good thing because we've had a busy weekend rounding up a family of racoons living in our attic and walls. The mother and four babies are being re-united and taken out south of Smithville to live in the country (see picture of Lizzie with baby racoons).

I'm reporting from the dialysis center. Right now there are, in my section of the room, 10 people receiving dialysis. There are 11 chairs facing inwards arranged in a rectangular circle, all with their dialysis machines beeping and humming beside them and connected to them with red tubes. Above and forward of each chair is a hanging TV that the patients watch and hear with their earphones. When I use my remote (clicker) to change the channel I have a 50% chance of also changing my neighbor's, or anyone else's too. So every once in awhile we hear someone say, "Sorry...".

The section of chairs adjacent to mine, and in the same configurtion, appears emptier, although I know there are a few people over there because the nurses and techs are attending to several chairs.

Today I am up to 4 hours of dialysis, from the 3 hours I had been getting up to now. So, what does that mean? Moving up to 4 hours optimizes my dialysis plan (developed by Dr. Moritz) for removing my toxins. Basically, about 40% of my blood is dialysized, and the fluid weight loss is the same with the increased time. The extra hour will reduce my URR and Kt/V, according to Phyllis. Even though she made it quite clear, my fuzzy brain wasn't able to capture the details so I looked them up later.

URR: Urea Reduction Level ~ The urea reduction ratio (URR) is one way of measuring dialysis adequacy — how much waste is removed by hemodialysis. If you receive hemodialysis three times a week, each treatment should reduce your urea level (also called BUN or blood urea nitrogen) by at least 65%.

Kt/V: K T over V ~ Kt/V ("kay tee over vee"), like URR, is a another measure of dialysis adequacy. Kt/V is a mathematical formula: K (clearance) multiplied by t (time) divided by V (volume), where:
> K = clearance—the amount of urea your dialyzer can remove (liters/minute)
> t = time—the duration of treatment (minutes)
> V = volume—the amount of body fluid (liters)
For example, if you have 50 L of body fluid and a dialyzer with a clearance of 0.25 L/min, to get a Kt/V of 1.2, you would need 240 minutes (4 hours) of dialysis per treatment. To clean your blood well, the dialyzer clearance rate (K) multiplied by the time on dialysis (t) should equal a little more than the total volume of fluid in your body (V)that needs to be cleaned.

My experience of sitting there for 4 hours made me a bit fidgety... there is a difference that feels like the syrup hour. I found myself clock-watching until I got wrapped up in NOVA's show on the "Cave of Letters". Then, when I was done at 7:50, I wanted to sit around and finish watching the TV. Some things never change: my focus on TV.