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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR Table of Contents   
Year : 1995  |  Volume : 6  |  Issue : 1  |  Page : 55-56
Offering Dialysis with Reduced Hours: Is it Justified?


Khartoum Dialysis and Kidney Transplant Center, Khartoum, Sudan

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How to cite this article:
Mohd. Suliman S, Solomon F, Babiker M, Tumash M, Musa AR. Offering Dialysis with Reduced Hours: Is it Justified?. Saudi J Kidney Dis Transpl 1995;6:55-6

How to cite this URL:
Mohd. Suliman S, Solomon F, Babiker M, Tumash M, Musa AR. Offering Dialysis with Reduced Hours: Is it Justified?. Saudi J Kidney Dis Transpl [serial online] 1995 [cited 2020 Jan 21];6:55-6. Available from: http://www.sjkdt.org/text.asp?1995/6/1/55/40902
Renal replacement therapy (RRT) for patients with end-stage renal disease (BSRD) by chronic dialysis or by transplantation is now well established, At present, there is no active transplantation program in Sudan, Most patients with BSRD are being treated by intermittent peritoneal dialysis (IPD), in use in Sudan since 1968, The Khartoum Dialysis Center for hemodialysis was started in 1985 and is now equipped with 12 hemodialysis (HD) machines and has nearly 50 patients on regular dialysis.

The disadvantage with RRT is the high cost involved. In a study in Saudi Arabia, HD was estimated to cost about 450 Saudi Riyals per patient per session [1] , In Sudan, the estimated cost for the drugs and disposables alone is about US$ 70 (equivalent to 21,000 Sudanese pounds) per patient per session (personal communication). Therefore, like many a developing country, we too find dialysis prohibitively expensive for our health authorities to undertake on a large scale, It will also be very expensive to expand the existing facilities, This really becomes a dilemmatic situation and many of our patients who are waiting for live related donor (LRD) renal transplantation could die if dialysis is not offered to them. One possible way out is to dialyse more patients with the existing facilities either by giving shorter dialysis or by giving it less frequently. But this could lead to underdialysis with associated complications [2] .

We evaluated hourly values of blood urea nitrogen (BUN), serum creatinine (Se Cr), phosphorus (PO4"") and uric acid (UA) in 44 patients (28 male, 16 female) with ESRD, with an age range between 14 and 75 years on regular hemodialysis. The values were estimated pre-dialysis, hourly during dialysis and immediate post-dialysis. At the time of the study 34 patients were on five hour dialysis and 10 were on four hour dialysis, both groups twice weekly, Vascular access was with arterio-venous (AV) fistula in 38 cases, AV shunt in three cases, prosthetic grafts in two cases and subclavian catheter in one case,

The BUN ranged between 45 and 109 (mean 75) mg/dl in predialysis samples, Post dialysis values ranged between 15 and 38 rag/ dl. Between 41 and 71.8% (mean 61.3%) of the initial BUN was cleared during the period of dialysis, There was no significant difference between those who were dialysed four or five hours. There was no correlation with age, sex or initial BUN levels. However, the mean clearance was higher (65.3%) in patients with an AV shunt.

The Se Cr levels ranged between 8.8 and. 28 (mean 15.5) mg/dl in pre dialysis samples. In post dialysis samples it ranged between 4.0 and 14.9 mg/dl. Between 39.6 and 62.0% of the initial Se Cr was cleared during the dialysis period. Reduction seen in hourly values of Se Cr was similar to that of BUN. Serum phosphate and uric acid levels returned to normal in all patients after 1-3 hours of commencing hemodialysis.

Based on these observations, the following changes were made in the dialysis prescription of our patients. In 15 patients with post dialysis BUN below 25 mg/dl, the dialysis hours were reduced by one hour. Five patients with an initial BUN below 55 mg/ dl were put on dialysis once/week under close observation along with strict dietary control. Following this, patients were kept under close observation, for a period of four weeks. Among them, four patients remained well, but one patient had to be put back on twice per week regime but the duration could be reduced to 4 hours. Thus it appears that, the dialysis time can be reduced in a select group of patients under close observation. The serial values of BUN and Se Cr show that, the major clearance occurs by the end of 3 hours and PO4 " " values normalize by the end of the 3rd hour. Some patients who used to have malaise, hypotension, vomiting and cramps towards the end of dialysis, reported that they were feeling better. Thus, we feel that, 5-8 hours of dialysis per week may be considered under special circumstances, at least for a short period, provided the patients are able to follow adequate dietary control.

 
   References Top

1.Aldrees A, Paul TT, Abu-Aisha H, ct al. A cost evaluation of hemodialysis in Ministry of Health Hospitals, Saudi Arabia: An NKF study. Saudi Kidney Dis Transplant Bull 1991;2(3):125-33.  Back to cited text no. 1    
2.Feinstein El, Kopple JD. Severe wasting and malnutrition in a patient undergoing maintenance dialysis (clinical conference). Am J Nephrol 1985;5(5):398-405.  Back to cited text no. 2    

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Correspondence Address:
Salma Mohd. Suliman
Consultant Nephtologist, Faculty of Medicine, Khartoum Dialysis and Kidney Transplant Center, P.O. Box 102, Khartoum
Sudan
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PMID: 18583845

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