Who is your patient?
62 year old female with diabetes, hypertension, and ESRD is maintained on chronic HD via a left brachio-basilic AVF. Her dialysis prescription is stable for 4 hour treatment on an Optiflux 180 dialyzer; Qb of 450ml/min; and Qd of 600ml/min.
Her measured Kt/Vurea typically results between 1.7-1.9 on this regimen. On a routine monthly measurement, she was noted to have an acute drop in Kt/Vurea to 1.3 which was confirmed on repeat measurement.
The nurses also noted some trouble cannulating the fistula, with infiltration during the last two dialysis treatments.