What would decrease the 'k' in the Kt/V formula?

Kt/V is a measure used to assess the adequacy of dialysis. In this formula, 'K' represents the dialyzer clearance of urea, 't' is the time of the dialysis session, and 'V' is the volume of distribution of urea. For Kt/V to be optimized, it's crucial for K (clearance) to be maximized effectively throughout the dialysis process.

Inadequate anticoagulation can lead to clotting within the dialyzer. When clotting occurs, some of the fibers within the dialyzer are obstructed, reducing the effective surface area available for the blood to contact the dialysate. This results in a decreased clearance of waste products, including urea, which directly impacts the value of 'K' in the Kt/V calculation. As K decreases due to inadequate anticoagulation, the overall effectiveness of the dialysis session suffers, lowering the Kt/V value and indicating that the treatment may not be adequately removing toxins from the blood.

In contrast, increasing blood flow rates and dialysate flow rates typically enhance the clearance, while proper needle insertion technique helps maintain proper blood flow and reduce complications.