Assessment of Adequacy of Hemodialysis and Nutritional Status in Patients on Maintenance Hemodialysis at Dialysis Centre

Background: In patients suffering from ESRD quality of life can be maintained by hemodialysis, CAPD or renal transplant. Adequate dose of hemodialysis is necessary for good quality of life. The hemodialysis adequacy is one of the most important issues influencing the survival of patients on maintenance hemodialysis. Aim: To compare Kt/V measurement by online clearance module with conventional enzymatic urea analysis method and to compare the nutritional status of patients who are adequately dialyzed with those who are inadequately dialyzed. Design: Cross sectional observational study. Setting: Department of Hemodialysis and Nephrology, Sheikh Zayed Hospital, Rahim Yar Khan Duration of Study with Dates: Six months (1 st August 2014 to 28 th February 2015). Methods: We studied 90 regular HD patients using Fresenius 4008S&H dialysis machines and BBraun dialogue+, equipped with online clearance modules (OCM) to measure Kt/V. OCM-based Kt/V was noted at the end of each dialysis session as well as pre and post dialysis sample were collected to measure urea clearance by using Daugirdaus equation to measure single pool Kt/V (conventional blood sampling method). Results: The Kt/V measured by OCM highly correlated with the one derived from conventional blood sampling method (r=0.80; p<0.01). The OCM-based method underestimated urea clearance by the mean of 7.3% and it varied greatly within individual patients with a mean of 1.39±0.24. Conclusion: The OCM-based method seems to be an easily obtained measure of the delivered dialysis dose, correlating well with standard equation based method of urea clearance. Substantial interdialysis session variations imply that repeated measures are necessary to obtain a real answer to the mean treatment dose being delivered to the patients.