The Assessment of Hemodialysis Adequacy among ESRD Patients in Ilorin using Urea Reduction Ratio

Abstract

Urea Reduction Ratio (URR) is a measure of adequacy of delivered dose of dialysis expressed as

a percentage reduction in blood urea level after a session of dialysis which is mathematically related to

Kt/V. Although Kt/V is recommended as the best measure of dialysis adequacy, URR is the most utilized

because of its simplicity with both methods having similar predictive power in terms of patient outcome.

In Nigeria, there is paucity of data on adequacy of haemodialysis and few available reports show that

inadequate dialysis is common. Since inadequate dialysis contributes significantly to poor patient survival, a one year retrospective appraisal of patients on maintenance haemodialysis at University of Ilorin Teaching Hospital (UITH), Ilorin was carried out to determine the adequacy of dialysis and patient

outcomeAll patients with end stage renal disease (ESRD) and were regular on at least twice weekly

haemodialysis of 4 hours per session were included in the study. Data was analyzed with SPSS version

Twelve out of 33 patients (36.4%) with ESRD on maintenance haemodialysis met the inclusion criteria. The mean age of the patients was 48.25 ± 17.85 with male to female ratio of 2:1. Majority were retired civil servants (33.3%), followed by serving civil servants (25.0%) and students (16.7%). The etiological factors of ESRD were Hypertensive nephrosclerosis (41.7%), CGN (33.3%), Diabetic nephropathy (25.0%) and chronic allograft dysfunction (8.3%). Mean URR was 41.83 ± 16.30% and overall mortality was 66.7%. The factors that contributed to inadequate dialysis and poor outcome were late presentation, uremic bleeding, septicemia, repeated blood transfusions and inability to sustain thrice weekly haemodialysis due to poor finances. In conclusion, inadequate haemodialysis is common in our patients and is associated with high mortality. Major contributory factors to poor outcome were ignorance and poor socioeconomic status There is need to intensify awareness program on early diagnosis of Chronic Kidney Disease. We recommend some form of renal replacement subsidy in the current National Health Insurance Scheme of the Federal Government.