Introduction: The burden of chronic kidney disease (CKD) is rapidly increasing in Tanzania. There is a rapid expansion of hemodialysis (HD) services to meet this demand. The quality of HD services, which is usually te...Introduction: The burden of chronic kidney disease (CKD) is rapidly increasing in Tanzania. There is a rapid expansion of hemodialysis (HD) services to meet this demand. The quality of HD services, which is usually termed HD inadequacy, is under-reported. Therefore, the objective of this study was to determine the prevalence of HD inadequacy using two equations, urea reduction ratio (URR) and Kt/V and its associated factors. The correlation between URR and Kt/V for the diagnosis of HD inadequacy is also determined. Materials and Methods: This was a prospective longitudinal study conducted from March to July 2021 in 98 patients with CKD who underwent maintenance HD at Bugando Medical Centre in Mwanza, Tanzania. Demographic, laboratory, and clinical information was collected and analyzed. The HD inadequacy was estimated by using both the URR and the Kt/V equations. The correlation between the two equations was analyzed by using Cohen’s kappa. Results: The majority (69.4%) of the study participants were male and the mean age was 59 (48 - 68) years. The median hemoglobin level was 10 (8.9 - 11.2) g/dl, and the pre-dialytic urea was 15 (10.6 - 21.3) mmol/L. The prevalence of HD inadequacy was 36 (36.7%). The predictors of HD inadequacy were older age (>50 years) (OR = 3.6, 95 % CI 1.0 - 12.6, p = 0.04), moderate or severe anemia (OR = 4.7, 95 % CI 1.5 - 14.4, p = 0.006) and short duration of HD (OR = 3.1, 95 % CI 1.0 - 9.1, p = 0.04). There was a strong agreement between URR and Kt/V in the diagnosis of HD inadequacy (Kappa = 0.887). Conclusion and Recommendations: HD inadequacy is common, and most predictors can be prevented. Clinicians should use a personalized approach in making sure that anemia is appropriately treated and HD prescription is adhered to for better clinical outcomes among patients with HD.展开更多
<strong>Introduction:</strong> Nx stage one machine results can help to enhance the clinical efficiency and shortage concerning the use of home hemodialysis. Therefore, the study investigates effectiveness...<strong>Introduction:</strong> Nx stage one machine results can help to enhance the clinical efficiency and shortage concerning the use of home hemodialysis. Therefore, the study investigates effectiveness of Nx stage machine for intermittent conventional hemodialysis in hospital for inpatients and outpatients to replace conventional hemodialysis in stable chronic hemodialysis patients. <strong>Methods:</strong> Prospective observatory study was conducted in Nephrology Division, King Fahd General Hospital from April 1 to June 1 2018. Patients with ESRD, who were dependent on dialysis and maintained on regular hemodialysis were recruited. Fifty-two sessions of hemodialysis were performed. The patients were given intermittent dialysis using Nx stage one machine. Pre and Post dialysis investigations and body weight were taken, and patients were observed for any complications during or post-dialysis. <strong>Findings:</strong> The primary endpoint ultrafiltration with a goal to remove 1 - 4 kg was achieved without any technical difficulty. Secondary endpoint for potassium reduction levels was achieved with mean SD post-dialysis 3.53 ± 0.3, and the tertiary endpoint was achieved in a patient less than 50 kg weight with spKt/V above 1.2. It was difficult to achieve spKt/V in patients with weight more than 60 kg due to limitations in the duration of sessions or dialysate volume. Target spkT/V was achieved for patients with body weight less than 50 kg;however, it was not achieved among the patients with body weight more than 60 kg. <strong>Discussion:</strong> Nx stage one machine can replace conventional intermittent dialysis in terms of ultrafiltration and Potassium correction;however, further investigation is needed for urea clearance.展开更多
文摘Introduction: The burden of chronic kidney disease (CKD) is rapidly increasing in Tanzania. There is a rapid expansion of hemodialysis (HD) services to meet this demand. The quality of HD services, which is usually termed HD inadequacy, is under-reported. Therefore, the objective of this study was to determine the prevalence of HD inadequacy using two equations, urea reduction ratio (URR) and Kt/V and its associated factors. The correlation between URR and Kt/V for the diagnosis of HD inadequacy is also determined. Materials and Methods: This was a prospective longitudinal study conducted from March to July 2021 in 98 patients with CKD who underwent maintenance HD at Bugando Medical Centre in Mwanza, Tanzania. Demographic, laboratory, and clinical information was collected and analyzed. The HD inadequacy was estimated by using both the URR and the Kt/V equations. The correlation between the two equations was analyzed by using Cohen’s kappa. Results: The majority (69.4%) of the study participants were male and the mean age was 59 (48 - 68) years. The median hemoglobin level was 10 (8.9 - 11.2) g/dl, and the pre-dialytic urea was 15 (10.6 - 21.3) mmol/L. The prevalence of HD inadequacy was 36 (36.7%). The predictors of HD inadequacy were older age (>50 years) (OR = 3.6, 95 % CI 1.0 - 12.6, p = 0.04), moderate or severe anemia (OR = 4.7, 95 % CI 1.5 - 14.4, p = 0.006) and short duration of HD (OR = 3.1, 95 % CI 1.0 - 9.1, p = 0.04). There was a strong agreement between URR and Kt/V in the diagnosis of HD inadequacy (Kappa = 0.887). Conclusion and Recommendations: HD inadequacy is common, and most predictors can be prevented. Clinicians should use a personalized approach in making sure that anemia is appropriately treated and HD prescription is adhered to for better clinical outcomes among patients with HD.
文摘<strong>Introduction:</strong> Nx stage one machine results can help to enhance the clinical efficiency and shortage concerning the use of home hemodialysis. Therefore, the study investigates effectiveness of Nx stage machine for intermittent conventional hemodialysis in hospital for inpatients and outpatients to replace conventional hemodialysis in stable chronic hemodialysis patients. <strong>Methods:</strong> Prospective observatory study was conducted in Nephrology Division, King Fahd General Hospital from April 1 to June 1 2018. Patients with ESRD, who were dependent on dialysis and maintained on regular hemodialysis were recruited. Fifty-two sessions of hemodialysis were performed. The patients were given intermittent dialysis using Nx stage one machine. Pre and Post dialysis investigations and body weight were taken, and patients were observed for any complications during or post-dialysis. <strong>Findings:</strong> The primary endpoint ultrafiltration with a goal to remove 1 - 4 kg was achieved without any technical difficulty. Secondary endpoint for potassium reduction levels was achieved with mean SD post-dialysis 3.53 ± 0.3, and the tertiary endpoint was achieved in a patient less than 50 kg weight with spKt/V above 1.2. It was difficult to achieve spKt/V in patients with weight more than 60 kg due to limitations in the duration of sessions or dialysate volume. Target spkT/V was achieved for patients with body weight less than 50 kg;however, it was not achieved among the patients with body weight more than 60 kg. <strong>Discussion:</strong> Nx stage one machine can replace conventional intermittent dialysis in terms of ultrafiltration and Potassium correction;however, further investigation is needed for urea clearance.
