Name of Test:
1. BUN (Blood Urea Nitrogen)
Normal Values:
Normal value = 7-25 MG/DL
Dialysis normal = 40-85 MG/DL
(values
will vary depending on protein intake)
Causes of Abnormal Values: Causes of abnormal levels
(refers to increases in):
- eating too much protein containing food
- could indicate need for more dialysis time
- could indicate need for higher blood flow rate
- could indicate need for a larger dialyzer
Signs and Symptoms:
Signs and symptoms associated with abnormal
levels:
- fatigue
- nausea
- insomnia
- dry and/or itchy skin
- urine-like body odor and/or breath
- taste and smell (senses) could be affected
Name of Test: 2. Calcium (Ca)
Normal Values:
Normal value = 8.5-10.8 MG/DL Dialysis normal = (Same) 8.5-10.8 MG/DL
Level is best near upper end to avoid overactive parathyroid glands.
Causes of Abnormal Values:
Causes of abnormal levels:
LOW:
- eating too much high phosphorus food
- not taking phosphorus binders as recommended
HIGH:
- medications such as Rocaltrol and/or Calderol may cause sharp increase.
- parathyroid gland removal may be indicated.
Calcium level will rise as phosphorus level
decreases.
Signs and Symptoms:
Signs and symptoms associated with abnormal
levels
LOW:
- muscle twitching and cramping
- seizures
- varying degrees of depression
- hair loss
- cataracts
- conjunctivitis (inflammation of the mucus membrane of inner eyelid)
HIGH:
- muscle weakness
- fatigue
- abdominal cramps
- loss of appetite
- nausea and /or vomiting
- constipation
- possible coma if left untreated
Name of Test: 3. Calcium Phosphate Product (Ca x
PO4)
Normal Values:
Normal value = 0-70
Dialysis normal = multiply calcium and phosphorus
blood values, the result should not exceed 70. For example, if your calcium level were 10 and you phosphorus lever were 8,
then you would have a Calcium PhosphateProduct of 80. This would be much too high. Some physicians even feel that a calcium
phospate product of below 50 is desirable.
Causes of Abnormal Values:
Signs and Symptoms:
Signs and symptoms associated with abnormal levels:
- High - calcification of blood vessels including coronary arteries.
This over time can can cause heart attack stroke and death.
Name of Test: 4. Chloride (Cl)
Normal Values:
Normal value = 96-109 MEQ/L
Dialysis normal = Same 96 - 109 MEQ/L
Causes of Abnormal Values:
Signs and Symptoms:
Signs and symptoms associated with abnormal levels:
Try to avoid such foods as
- canned vegetables
- potato chips, etc.
- bacon
- luncheon meats (bologna, salami, etc.)
Name of Test: 5. Creatinine
Definition of Creatinine/Creatinine Clearance:
Serum creatinine level and "creatinine clearance" are different ways
of determining kidney function. Creatinine is a protein produced by muscle and released into the blood. The amount produced
is relatively stable in a given person. The creatinine level in the serum is therefore determined by the rate it is being
removed, which is roughly a measure of kidney function. If kidney function falls (say a kidney is removed to donate to a relative),
the creatinine level will rise. Normal is about 1 for an average adult. Infants that have little muscle
will have lower normal levels (0.2). Muscle bound weight lifters may have a higher normal creatinine.
Creatinine clearance is technically the amount of blood that is "cleared"
of creatinine per time period. It is usually expressed in ml per minute. Normal
is 120 ml/min for an adult. It is roughly, inversely related to serum creatinine: If the clearance drops to one half of the
old level, the serum creatinine doubles (in the steady state). So for an adult, serum creatinine of 2 is roughly a creatinine
clearance of 60 ml/min; creatinine 3 is roughly a clearance of 30; creatinine of 4 is roughly a clearance of 15, etc. So why
didn't the creatinine rise to only 2 when a kidney was removed? (I said it would rise to 1.8) The answer is that the remaining
kidney "hyperfilters" and seems to work harder, therefore kidney function is not quite halved.
Usually, an adult will need dialysis because symptoms of kidney failure
appear at a clearance of less than 10 ml/min. Creatinine clearance has to be measured by urine collection (usually 12 or 24
hours). It is a more precise estimate of kidney function than serum creatinine since it does not depend on the amount of muscle
one has.
Note that the units used in the United States are milligrams per deciliter (mg/dl). To convert to international
units (micromoles per liter) multiply the creatinine (in mg/dl) by 88. Thus a serum creatinine of 2mg/dl is the same as 176
micromoles per liter.
Normal Values:
Normal value = less than 1.5 MG/DL
Accepted dialysis normal = 10-20
MG/DL
Varies with muscle mass. Elderly may have lower creatinine due to loss
of muscle mass. Type II Diabetics have an acceptable range of 4-6 MG/DL. Should remain about the same as at start of dialysis
from treatment to treatment. Only the most muscular of individuals should have values in the upper range. Desirable levels
are in the low teens.
Causes of Abnormal Values:
Causes of abnormal levels:
- inadequate "real" dialysis time
- increase in muscle mass
Signs and Symptoms:
Signs and symptoms associated with abnormal
levels:
Non-specific symptoms, but should be closely
monitored with special attention to unsteady values. Any changes, especially increases, should be discussed with your care
team immediately.They may indicate a failing access
Name of Test:
6. CO2 (Bicarb)
Normal Values:
Normal value = 22-32 MEQ/L
Dialysis normal = not less than 18 MEQ/L
Causes of Abnormal Values:
Causes of abnormal levels:
- Eating to much protein, and creating a more acid blood, thus lowering
CO2
Signs and Symptoms:
Signs and symptoms associated with abnormal
levels:
- Rapid breathing and shortness of breath
- Acidosis in Type I Diabetics
Name of Test:
7. Glucose
Normal Values:
Normal value = 65-115 MG/DL
Accepted dialysis normal = Same 65-115
MG/DL
Causes of Abnormal Values:
HIGH:
LOW:
Will be slightly higher within 1-3 hours
after eating a meal.
Signs and Symptoms:
Signs and symptoms associated with high
levels:
Name of Test:
8. Hematocrit (Hct)
Normal Values:
Normal value: % of total blood volume made up of red blood cells
- Males = 40% - 54%
- Females = 37% - 47%
Dialysis normal (following Medicare guideline)
- 30% - 36% (gender non-specific)
Causes of Abnormal Values:
Causes of abnormal levels:
- decreased production of red blood cells
- blood loss during or after dialysis
- shortened survival time of red blood cells
Signs and Symptoms:
Signs and symptoms associated with abnormal
levels:
- Fatigue
- shortness of breath
- chest pain on exertion (if underlying heart disease is present)
Name of Test:
9. Magnesium (Mg)
Normal Values:
Normal value = 1.7 - 2.3 MG/DL
Dialysis normal = Same 1.7 - 2.3 MG/DL
Causes of Abnormal Values:
Causes of abnormal levels:
- elevated due to taking phosphate binder containing magnesium
- ingesting medication such as milk of magnesia or citrate of magnesium
Signs and Symptoms:
Signs and symptoms associated with abnormal
levels:
- decreased mental function ranging from drowsiness to coma in severe
states
- decreased tendon reflex leading to paralysis
- Nausea / vomiting
- hypotension due to dilated blood vessels
Name of Test:
10. Sodium (Na)
Normal Values:
Normal value = 135 - 147 MEQ/L
Dialysis normal = Same 135 -147 MEQ/L
Causes of Abnormal Values:
Causes of abnormal levels:
- eating too much salt (found in canned vegetables, potato chips, bacon,
etc.)
- High sodium levels in diaysate
Signs and Symptoms:
Signs and symptoms associated with abnormal
levels:
- thirst - leads to drinking more fluids and results in fluid weight
gain
- elevated blood pressure (hypertension)
- shortness of breath
Note: Lower levels in your dialysate will
cause you to be less thirsty. But lower levels will also lead to lower blood pressure. As long as your blood pressure will
stay high enough to tolerate them, constnat dialysate levels as low as 135 to 137 will significantly reduce thirst.
(If you are to tolerate such low levels
you must limit your weight gain to 3 or 4 pounds between treatments. Lowering your weight gain may seem almost impossible
if your blood sodium is high already. It is much easier once your blood levels become lower)
While gradually lowering sodum levels during
diaysis ("sodium modeling") is better than high levels during the entire run, constant low levels during the run are even
better in allowing you to leave the dialysis session with a low level of sodium in your body and thus a resulting decrease
in thirst between treatments.
Name of Test:
11.Phosphorus (PO4)
Normal Values:
Normal value = 2.5 - 4.5 MG/DL
Dialysis normal = 3.5 - 5.5 MG/DL
Causes of Abnormal Values:
Causes of abnormal levels:
LOW:
- taking too much phosphate binder
HIGH:
- not taking phosphate binders
- eating high phosphorus foods such as milk, beans, cheese, and organ
meats
Signs and Symptoms:
Signs and symptoms associated with abnormal
levels:
- causes elevated parathyroid hormone by lowering calcium (Ca). Elevated
parathyroid hormone cannot be felt but will cause terribly serious bone destruction over time.
- itchy skin
Name of Test:
12. Potassium
Normal Values:
Normal value = 3.5 - 5.4 MEQ/L
Dialysis normal = 4.00 - 6.5 MEQ/L
Causes of Abnormal Values:
Causes of abnormal levels:
HIGH:
- eating too many foods high in potassium (bananas, oranges, potatoes,
beans, nuts or replacement of cooking/table salt by a potassium containing substitute)
Signs and Symptoms:
Signs and symptoms associated with abnormal
levels:
HIGH:
- above 7.0 MEQ/L, extreme weakness (usually) prior to cardiac arrest.
Name of Test:
13. Albumin
Normal Values:
Normal value = 3.5 - 5.5 G/DL
Dialysis normal = Above 3.8 G/DL
Reason for test:
- Measure of nutritional adequacy
Name of Test:
14. Ferritin
Normal Values:
Normal value = 10 - 350 NG/ML
Dialysis normal = 200 - 500 NG/ML
Reason for test:
- a measure of "stored" iron
Name of Test:
16 Total Bilirubin
Normal Values:
Normal value = 0.2 - 1.2 MG/DL
Dialysis normal = Same
Reason for test:
- elevated level indicates liver damage possibly from Hepatitis or obstructed
bile ducts
Name of Test:
17. Total Protein
Normal Values:
Normal value = 6 - 8.5 GM/DL
Dialysis normal = Same
Reason for test:
- observed for detecting abnormally low levels when increased intake
of protein foods have been initiated
Name of Test:
18. Urea Reduction Ratio (URR)
Normal Values:
Dialysis normal = greater than 65%. This means that more than 60% of
the urea (a waste product of the body) in your system has been removed by dialysis.
Reason for test:
- determines dialysis efficiency
Name of Test:
19. KT/V
Normal Values:
Dialysis normal:
Hemodialysis = 1.3 or higher
Peritoneal Dialysis
= 2.0 or higher
Reason for test: A different calculation of urea removal. Some centers
prefer it to URR and some prefer URR to KT/V. There is no real difference in what is measured, the choice is simply a matter
of preference.
- checks dialysis efficiency
Name of Test:
20. Alkaline Phosphatase
Normal Values:
Normal value = 30 -115 U/ML
Dialysis normal = Same, Alkaline Phosphatase
is derived from bone or liver.
Causes of Abnormal Values:
Causes of high levels: Hyperparathyroidism, liver disease
BONE
- a marker for the severity of parathyroid caused bone disease
LIVER
- a marker for diseases involving the liver or gall bladder
Signs and Symptoms:
Signs and symptoms associated with abnormal
levels:
- painful joints
- weakened bones which could lead to severe pain and/or deterioration
requiring surgery (hyperparathyroidism)
Name of Test:
21. Parathyroid Hormone (PTH)
Normal Values:
Normal value = Check "normals" for your lab, probably they will be below
200.
Dialysis normal = Same
Causes of Abnormal Values:
Causes of abnormal levels:
- long term imbalance of calcium and phosphorus
Signs and Symptoms:
Signs and symptoms associated with abnormal
levels:
HIGH
- not taking phosphate binders
- eating high phosphorus foods such as milk, beans, cheese, and organ
meats
Name of Test:
22. SGOT
Normal Values:
Normal value = 10 - 50 U/ML
Dialysis normal = Same
Causes of Abnormal Values:
Causes of abnormal levels:
Signs and Symptoms:
Signs and symptoms associated with abnormal
levels:
- sometimes, no symptoms are displayed
- nausea and vomiting
- abdominal cramping
- fatigue (if severe liver damage is present)
Name of Test:
23. SGPT
Normal Values:
Normal value = 7 - 33
Dialysis normal = Same
Causes of Abnormal Values:
Causes of abnormal levels:
Signs and Symptoms:
Signs and symptoms associated with abnormal
levels:
- sometimes, no symptoms are displayed
- nausea and vomiting
- abdominal cramping
- fatigue (if severe liver damage is present)
