Correspondence Address:
Chaturaka Rodrigo
University Medical Unit, National Hospital of Sri Lanka, Colombo
Sri Lanka

Full Text

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. [1] 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. [2],[3] 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.

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