Comparison of urea reduction ratio and dialysis efficacy in evaluating haemodialysis adequacy in chronic kidney disease patients in Wangaya Hospital
DOI:
https://doi.org/10.18203/2349-3933.ijam20222097Keywords:
Adequacy of hemodialysis, CKD, URR, Kt/VAbstract
Background: An increasing number of patients with chronic kidney disease (CKD) impact an increased need for hemodialysis. Inadequate hemodialysis affects morbidity in patients with CKD. Determination of the urea removal index can be accomplished by several invasive and non-invasive methods. The purpose of this study was to compare the urea reduction ratio (URR) and dialysis efficiency (Kt/V) calculated automatically by hemodialysis machines to assess the adequacy of hemodialysis in patients with CKD.
Methods: A cross-sectional analysis study was conducted on 58 CKD patients with age ≥18 years, conventional 5-hour hemodialysis sessions twice weekly, using single use-hollow fiber dialyzers, and who had been receiving hemodialysis for ≥6 months in the hemodialysis unit at Wangaya Hospital from April 2022 to May 2022. Study data were obtained from medical records then described and analyzed using the statistical package for the social sciences (SPSS) program.
Results: The mean of URR was 70.74±10.04, while the mean of Kt/V delivered by machine was 1.27±0.19. More hemodialysis patients received adequate hemodialysis based on URR parameters compared to Kt/V parameters (84.5% versus 1.7%). There was no significant difference between age, sex, body mass index (BMI), comorbidities, vascular access and duration of dialysis with adequacy hemodialysis. There was a significant difference between URR and Kt/V in the evaluation adequacy of hemodialysis (p=0.000). In addition, there was a positive correlation between URR and Kt/V in the evaluation adequacy of hemodialysis (r=0.592, p=0.000).
Conclusions: The URR is a more accurate parameter, but the Kt/V delivered by machine can help the URR demonstrate the adequacy of haemodialysis patients with CKD.
References
Thurlow JS, Joshi M, Yan G, Norris KC, Agodoa LY, Yuan CM. Global epidemiology of end-stage kidney disease and disparities in kidney replacement therapy. Am J Nephrol. 2021;52:98-107.
Riset Kesehatan Dasar (Riskesdas). 2018. Badan Penelitian dan Pengembangan Kesehatan Kementrian Kesehatan RI. Available at: https://kesmas.kemkes.go.id/assets/upload/dir_519d41d8cd98f00/files/Hasil-riskesdas-2018_1274.pdf. Accessed on 09 March 2022.
Vanholder RC, Ringoir SM. Adequacy of dialysis: a critical analysis. Kidney Int. 1992;42(3):540-58.
Ansell D, Roderick P, Hodsman A, Ford D, Steenkamp R, Tomson C. UK Renal registry 11th annual report. Nephron Clin Pract. 2009;111(1):113-9.
Hakim PRM. Assessing the adequacy of dialysis. Kidney Int. 1990;37(2):822-32.
Hakim RM, Breyer J, Ismail N, Schulman G. Effects of dose dialysis on morbidity and mortality. Am J Kidney Dis. 1994;23(5):661-9.
Suwitra K. Penyakit ginjal kronis. In: Sudoyo AW, Setiyohadi B, Alwi I, Simadibrata KM, Setiati S. Buku Ajar Ilmu Penyakit Dalam. 5th ed. Jakarta: FK UI; 2009: 1035-1040.
Somji SS, Ruggajo P, Moledina S. Adequacy of hemodialysis and its associated factors among patients undergoing chronic hemodialysis in dar es salaam, Tanzania. Int J Nephrol. 2020;9863065.
Dialysis Outcomes Quality Initiative (DOQI) Clinical practice guidelines and clinical practice recommendations updates for hemodialysis adequacy, 2006. Available at: https://www.kidney.org/sites/default500210_jp_guidelin. Accessed on 09 March 2022.
11th Report of Indonesian Renal Registry. PERNEFRI, 2018. Available at: https://www.indonesianrenalregistry.org/data/IRR%202018.pdf. Accessed on 27 June 2022.
KDIGO. Clinical practice guideline for the evaluation and management of chronic kidney disease. Kid Int. 2013;1(3):18-27.
Baloglu I, Selcuk NY, Evran H, Tonbul HZ, Turkmen K. Evaluation of hemodialysis adequacy: correlation between Kt/Vurea and other methods. Turk J Nephrol. 2019;28(3):193-6.
Widiana IGR. Preskripsi dan adekuasi hemodialisis. Medicina Jurnal Ilmiah Kedokteran. 2013:44(4).
Rasul MM, Rahman AKMM, Anessa, Khan AS, Hussain T. Assesment of hemodialysis adequacy in patients with end stage renal disease in a military hospital of Dhaka, Bangladesh. J Bangladesh Coll Phys Surg. 2019:37(4).
Anees M, Malik MR, Abbasi T, Nasir Z, Hussain Y, Ibrahim M. Demographic factors affecting quality of life of hemodialysis patients - Lahore, Pakistan. Pak J Med Sci. 2014;30(5):1123-7.
Tayyebi A, Savari S, Nehrir B, Rahimi A, Eynollahi B. The effect of Vitamin B12 supplemention on fatigue in hemodialysis patients. Iran J Crit Care Nurs. 2013;6:39‑48.
Rezaiee O, Shahgholian N, Shahidi S. Assessment of hemodialysis adequacy and its relationship with individual and personal factors. Iran J Nurs Midwifery Res. 2016;21(6):577-82.
Utami AS, Asmara IGY, Irawati D. Hubungan adekuasi hemodialisis dengan status gizi pasien penyakit ginjal kronis yang menjalani hemodialisis regular di RSUD Kota Mataram. Jurnal Kedokteran Unram. 2021;10(3):502-8.
Nunes FT, Campos G, Paula SMX, Merhi VAL, Portero-Mclelan KC, Motta DG et al. Dialysis adequacy and nutritional status of hemodialysis patients. Hemodialysis Int. 2008;12:45-51.
Shariati AR, Asayesh H, Nasiri H, Tajbakhsh R, Hesam M, Mollaee E, et al. To compare dialysis adequacy in patient’s that referred to Golestan province hemodialysis centers. Health Inf Manag. 2012;1:56‑64.
Roozitalab M, Moohamadi B, Najafi SH, Mehrabi S. Determining the adequacy of hemodialysis in hemodialysis units of Kohgilouyeh and Boyerahmad hospitals in 2009. Armaghane Danesh. 2010;15:273-82.
Daugirdas JT. Eliminating the need for routine monthly postdialysis serum urea nitrogen measurement: A method for monitoring Kt/V and normalized protein catabolic rate using conductivity determined dialyzer clearance. Semin Dial. 2018;31(6):633-6.
Kim HW, Heo SJ, Kim JY, Kim A, Nam CM, Kim BS. Dialysis adequacy predictions using a machine learning method. Scientific Reports. 2021;11:15417.
