Objective The purpose of this study was to investigate the clinical characteristics of inadequate dialysis in hemodialysis patients, so as to provide the evidences for improving clinical diagnosis and
treatment of inadequate dialysis and promoting dialysis adequacy. Methods This study was a multi- center
and cross-sectional survey. We retrospectively analyzed the patients with the single pool Kt/V (spKt/V) <1.2 in
a measurement during January to March 2018 from 12 centers. Their demographic, treatment prescription, actual treatment and residual renal function data were collected and analyzed. SPSS 22.0 statistical software was
used for data analysis, and Spearman correlation analysis was used to test the correlation between body
weight after dialysis, blood flow rate (BFR), and weight-normalized BFR. Results A total of 224 patients
were enrolled in this study. Their average age was 58.2±13.3 years, and the male to female ratio was 5.2:1.
The prescribed spKt/V was 1.39±0.29, and the measured spKt/V was 1.06±0.11. In the 117 (52.2%) patients
whose prescribed Kt/V was <1.4, the KoA of dialyzer (t=-8.619, P<0.001), BFR (t=-3.846, P＜0.001) and
weight-normalized BFR (t=-12.577, P＜0.001) were significantly lower than those in spKt/V ≥1.4 group. In
the 224 patients, weight-normalized BFR decreased gradually with the increase of body weight (ρ=-0.666, P<
0.001). There were 42 patients (18.8%) whose dialysis time was less than 240min, and 35 patients (15.6%)
with blood coagulation in dialyzer. Residual native kidney function was present in 87 patients (38.84%); 14 of
the 87 patients were tested for residual renal function, of which 5 patients fulfilled the standard Kt/V after combination of the Kt/V values from residual renal function and dialysis. Conclusion Insufficient dialysis in hemodialysis patients may relate to the lower prescribed Kt/V, lower weight-normalized BFR, shorter dialysis
time, blood coagulation in dialyzer, unreasonable calculation methods for dialysis adequacy, and acute complications during hemodialysis sessions.
JIANG Zhen-Bin
,
GAN Liang-Ying
,
LI Zhong-Xin
,
SHEN Yu-Lan
,
ZHAO Xiao-Lin
,
MA Ying-Chun
,
YU Yong-Wu
,
QI Gui-Jing
,
LI Wei-Hua
,
XU Ming-Cheng
,
ZHANG Dong-Liang
,
ZUO Li
,
WANG Mei
. Multicentre Analysis of Clinical Characteristics in Maintenance Hemodialysis Patients with Inadequate Dialysis[J]. Chinese Journal of Blood Purification, 2022
, 21(07)
: 507
-511,540
.
DOI: 10.3969/j.issn.1671-4091.2022.07.010
[1]National Kidney Foundation.KDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 update[J].Am J Kidney Dis, 2015, 66(5):884-930
[2]Alyousef A, Alghareeb S, Al W J, et al.Hemodialysis delivery,dialysis dose achievement,and vascular access types in hemodialysis patients from the Gulf Cooperation Council countries enrolled in the dialysis outcomes and practice patterns study phase 5 (2012-2015)[J].Saudi J Kidney Dis Transpl, 2016, 27(6 Suppl 1):S42-S50
[3]El-Sheikh M, El-Ghazaly G.Assessment of hemodialysis adequacy in patients with chronic kidney disease in the hemodialysis unit at Tanta University Hospital in Egypt[J].Indian J Nephrol, 2016, 26(6):398-404
[4]Barzegar H, Moosazadeh M, Jafari H, et al.Evaluation of dialysis adequacy in hemodialysis patients: A systematic review[J].Urol J, 2016, 13(4):2744-2749
[5]Borzou S R, Gholyaf M, Zandiha M, et al.The effect of increasing blood flow rate on dialysis adequacy in hemodialysis patients[J].Saudi J Kidney Dis Transpl, 2009, 20(4):639-642
[6]Gotta V, Marsenic O, Pfister M.Age- and weight-based differences in haemodialysis prescription and delivery in children,adolescents and young adults[J].Nephrol Dial Transplant, 2018, 33(9):1649-1660
[7]Caplin B, Kumar S, Davenport A.Patients' perspective of haemodialysis-associated symptoms[J].Nephrol Dial Transplant, 2011, 26(8):2656-2663
[8]Morfin J A, Fluck R J, Weinhandl E D, et al.Intensive Hemodialysis and Treatment Complications and Tolerability[J].Am J Kidney Dis, 2016, 68(5S1):S43-S50
[9]Kobrin S M, Berns J S.Quinine--a tonic too bitter for hemodialysis-associated muscle cramps?[J].Semin Dial, 2007, 20(5):396-401
[10]Murea M, Russell G B, Daeihagh P, et al.Efficacy and safety of low-dose heparin in hemodialysis[J].Hemodial Int, 2018, 22(1):74-81
[11]Sands J J, Kotanko P, Segal J H, et al.Effects of citrate acid concentrate (citrasate(R)) on heparin N requirements and hemodialysis adequacy: a multicenter,prospective noninferiority trial[J].Blood Purif, 2012, 33(1-3):199-204
[12]Canaud B, Leray-Moragues H, Kerkeni N, et al.Effective flow performances and dialysis doses delivered with permanent catheters: a 24-month comparative study of permanent catheters versus arterio-venous vascular accesses[J].Nephrol Dial Transplant, 2002, 17(7):1286-1292
[13]Cortez A J, Paulson W D, Schwab S J.Vascular access as a determinant of adequacy of dialysis[J].Semin Nephrol, 2005, 25(2):96-101
[14]Moura A, Madureira J, Alija P, et al.Type of vascular access and location in online hemodiafiltration and its association with patient's perception of health-related quality of life[J].J Vasc Access, 2014, 15(3):175-182
[15]Mutevelic A, Spanja I, Sultic-Lavic I, et al.The impact of Vascular Access on the Adequacy of Dialysis and the Outcome of the Dialysis Treatment: One Center Experience[J].Mater Sociomed, 2015, 27(2):114-117
[16]Tonelli M, Muirhead N.Access type as a predictor of dialysis adequacy in chronic hemodialysis patients[J].ASAIO J, 2000, 46(3):279-282
[17] Piccoli G B, Nielsen L, Gendrot L, et al.Prescribing Hemodialysis or Hemodiafiltration: When One Size Does Not Fit All the Proposal of a Personalized Approach Based on Comorbidity and Nutritional Status[J].J Clin Med, 2018, 7(7):10-10
[18]Hauk M, Kuhlmann M K, Riegel W, et al.In vivo effects of dialysate flow rate on KtV in maintenance hemodialysis patients[J].Am J Kidney Dis, 2000, 35(1):105-111
[19]Agarwal R, Georgianos P.Feeding during dialysis-risks and uncertainties[J].Nephrol Dial Transplant, 2018, 33(6):917-922
[20]Kong J, Davies M, Mount P.The importance of residual kidney function in haemodialysis patients[J].Nephrology (Carlton), 2018, 23(12):1073-1080
[21]Moist L M, Port F K, Orzol S M, et al.Predictors of loss of residual renal function among new dialysis patients[J].J Am Soc Nephrol, 2000, 11(3):556-564
