LETTER TO THE EDITOR
Year : 2010 | Volume
: 21 | Issue : 6 | Page : 1145--1146
Adequacy of hemodialysis in patients with chronic kidney disease in Sri Lanka: A prospective study
Chaturaka Rodrigo1, Rushika Lanerolle2, Carukshi Arambepola2,
1 University Medical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
2 Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
University Medical Unit, National Hospital of Sri Lanka, Colombo
|How to cite this article:|
Rodrigo C, Lanerolle R, Arambepola C. Adequacy of hemodialysis in patients with chronic kidney disease in Sri Lanka: A prospective study.Saudi J Kidney Dis Transpl 2010;21:1145-1146
|How to cite this URL:|
Rodrigo C, Lanerolle R, Arambepola C. Adequacy of hemodialysis in patients with chronic kidney disease in Sri Lanka: A prospective study. Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2019 Dec 16 ];21:1145-1146
Available from: http://www.sjkdt.org/text.asp?2010/21/6/1145/72311
To the Editor,
Adequacy of dialysis is a cause of concern for both nephrologists and patients in any dialysis program. We carried out a prospective study on adequacy of hemodialysis (HD) for patients with Chronic Kidney Disease (CKD) at the dialysis unit of the National Hospital of Sri Lanka (NHSL), which is the major tertiary care referral center in Sri Lanka. Dialysis adequacy was assessed by calculating the Kt/V [K is the urea clearance of the dialysis membrane (mL/min), t is the duration of dialysis (min) and V is the volume of distribution of urea in the patient (mL)] value for each individual dialysis.  We also compared the prescribed dialysis dose and the received dose for each patient.
The study recruited all patients (exclusively dialyzed at NHSL) with CKD admitted to the University Medical Unit during the study period. Calculations were done by a computer program which required pre-dialysis and postdialysis blood urea nitrogen (BUN), post-dialysis body weight, amount of ultrafiltration and duration of dialysis as input data. The postdialysis BUN was measured with a blood sample drawn within 2-5 mins after completion of a dialysis session. Hundred and thirty eight dialysis sessions in 31 patients (18 males, 13 females) were assessed. A Kt/V value of 1.2 or greater was taken as a measure of adequacy of dialysis. For individual dialysis sessions, only 39 (28.2 %) had a Kt/V value equal to, or greater than 1.2. Only three patients (9.7%) out of 31 received the prescribed dialysis dose of at least three sessions per week.
There can be several reasons for the observed deficiencies. They include: inadequate duration of dialysis, quality of dialyzer membrane, poor vascular access and slow flow rates of blood and dialysate. , However, the most important issue seems to be the non-availability of adequate number of HD machines (only 8 machines for a hospital with a bed strength over 1000). Being the premier tertiary care center in the country, NHSL receives many patients needing HD from other parts of the country and at any given time, approximately 50-60 patients are awaiting dialysis. We recommend that further quality control measures, in detail review of factors that will improve efficiency, periodic audits and increasing the number of HD machines are some urgent measures to improve the service.
|1||Depner TA. Prescribing hemodialysis: a guide to urea modeling. Boston: Kluwer Academic. 1991.|
|2||Pastan S, Baily J. Dialysis therapy. N Engl J Med 1998;338:1438.|
|3||Held PJ, Port FK, Wolfe RA, et al. The dose of hemodialysis and patient mortality. Kidney Int 1996;50:550-6.|