Evaluation of hemodialysis adequacy in patients with CKD in the hemodialysis unit at SBMCH, Barishal

Abstract

Background: Chronic kidney disease (CKD) is a progressive loss in kidney function over a period of months or years. According to the World Health Organization (WHO) data published in 2018 Kidney Disease Deaths in Bangladesh reached 16,948 or 2.18% of total deaths. The age adjusted Death Rate is 14.83 per 100,000 of population ranks Bangladesh #94 in the world. Review other causes of death by clicking the links below or choose the full health profile.^[1] In Bangladesh, chronic kidney diseases is one of the major problems. Albeit it has been considered arduous for poor to bring up the cost, they have to rely on this treatment in the final stage of renal diseases. Worldwide, hemodialysis constitutes the most common form of renal replacement therapy and many studies have shown strong correlation between Hemodialysis dose and clinical outcome measured by Kt/V. Objectives: The primary purpose of this cross sectional study is the evaluation of hemodialysis adequacy in patients with end-stage renal disease on maintenance of hemodialysis. Methods and Martials: This cross-sectional study was conducted on 55 patients in the Hemodialysis unit of Nephrology Department at Shere-e-Bangla Medical College and Hospital, Barishal (SBMCH). Study period was one year from January, 2020 to December, 2020. A questionnaire was prepared by the researcher considering the key variable like age, sex, presenting symptoms, clinical findings, associated medical conditions, investigations preoperative findings, outcome was verified by the guide. SpKt/V was used to assess the adequacy and URR of Hemodialysis. Statistical analysis was carried out for all collected data using SPSS 23, chi-square test and a logistic regression analysis. P-value was determined less than 0.05 which is statistical significant. Results: The proportion of patients receiving adequate hemodialysis among patients undergoing chronic hemodialysis based on URR was 34.3% and based on Kt/V was 40.6%. By Kt/V criteria, males had significantly a higher prevalence of inadequate hemodialysis (66.6% versus 47.4%, p value 0.047) but not by URR criteria (69.4% versus 57.1%, p value 0.138). Patients using a dialyzer surface area of less than 1.4 m² had significantly more inadequate hemodialysis as compared to those with dialyzer surface area ≥1.4 m² (68.8% versus 42.9%, p value 0.022, by URR criteria (85.7% versus 10%, p value 0.032, by Kt/V criteria). In Kt/V measures, patients who had hemoglobin of <10 g/ dl in the last month had significantly more inadequate hemodialysis as compared to those who had hemoglobin of ≥10 g/dl. This association was not seen when using URR criteria (70.8% versus 61.3%, p value 0.201, by URR criteria) (69.8 versus 51.6%, p value 0.028, by Kt/V criteria). Our findings clearly showed a strong positive correlation between dialysis dose and Hemodialysis level, serum albumin level, normalized protein catabolic rate, and physical health. Conclusion: Hemodialysis inadequacy is frequent in SBMCH and is associated with male gender, dialyzer surface area, and hemoglobin level. Hemodialysis adequacy was influenced by several factors such as duration and frequency of the dialysis session, patients’ complaints, and well-functioning vascular access. Giving the correct hemodialysis dose could help improve hemodialysis adequacy.