A Retrospective Analysis of Factors Influencing Maintenance Hemodialysis Adequacy: A Single-center Study in Eastern...

Quality of life in maintenance hemodialysis (MHD) patients is dependent on adequate hemodialysis. Kt/V, which gauges urea clearance, serves as the standard metric for assessing the effectiveness of MHD. According to the 2006 guidelines from the NKF-KDOQI, a spKt/V exceeding 1.2 or a urea reduction ratio (URR) of 65% is advised for maintenance hemodialysis conducted three times weekly. This study was aimed at determining the adequate hemodialysis sessions and their associated factors for patients undergoing maintenance hemodialysis sessions at our center.

The study was conducted over a 1-year period at Medica Hospital in Kolkata, focusing on patients receiving maintenance hemodialysis three times per week. Kt/V levels were assessed using the Online Clearance Monitoring (OCM) technique.

The study included 251 participants, consisting of 170 (67.72%) men and 81 (32.28%) women, with a mean age of 59.09 ± 13.00 years. Diabetes was the most frequently observed underlying condition, affecting 138 patients (55.4%), while fistula was the predominant type of vascular access, utilized in 198 patients (79%). Hemodialysis adequacy was achieved in 81.08% of MHD sessions. Patients on high-flux dialyzers achieved a higher average Kt/V compared to patients on low-flux dialyzers. Dialyzer clotting was associated with a decline in Kt/V. The study found that MHD adequacy was inversely related to both age and predialysis systolic blood pressure, while it showed a direct correlation with the duration of hemodialysis. Additionally, females attained higher Kt/V values compared to males. Logistic regression analysis identified male gender and blood flow as independent determinants of hemodialysis adequacy.

MHD adequacy is determined by a combination of factors rather than a single variable. Our findings indicate that achieving MHD adequacy requires a combination of sufficient treatment duration, appropriate rate of blood flow, effective anticoagulation for prevention of clotting, stable blood pressure management, and the use of hemodialyzers with a surface area exceeding 1.2 m^2.