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Journal ArticleDOI

A comparison of adequacy and complications of hemodialysis: A quasiexperimental study

01 Jan 2018-Biomedical Research-tokyo (Allied Academies)-Vol. 29, Iss: 17, pp 3389-3394
TL;DR: Although the increase in blood flow and dialysis fluid flow in the stepwise method leads to an increase in the adequacy of dialysis, but they are not safe due to their complications and side effects.
Abstract: Background: Hemodialysis, as one of the most commonly used chronic renal failure treatments, increases the level of blood toxins, complications of illness, hospitalized days, imposed costs, and mortality if it does not have the required quality. One of the factors that can be effective in increasing dialysis adequacy in case of patient tolerance and lack of complications is an increasing blood flow, the stepwise profile of dialysis fluid flow. The present study intends to compare these methods in terms of efficiency in increasing the dialysis adequacy against their complications. Materials and Methods: In this semi-experimental single-group study, before and after-intervention trials, 22 patients with hemodialysis under the coverage of Special Patients Center in Zabol, who had the criteria to be included in the study were selected by random sampling method and underwent dialysis for 4 sessions using routine methods, increasing blood flow, stepwise profile of dialysis fluid flow, while maintaining all parameters (such as the type of fluid, type and concentration of dialysis fluid, shifts, etc.). At the beginning and the end of the each dialysis session in two methods, the BUN sample was taken before and after dialysis to study the adequacy of dialysis. During the 12 sessions of dialysis, patients were examined before dialysis in terms of lack of hypertension and some symptoms including nausea, vomiting, muscle cramps and other symptoms and then they were monitored directly every 30 min for hypertension, nausea, vomiting, muscle cramps, headaches, and so on. Results: The mean score of adequacy of dialysis was 0.834 ± 0.22 in the routine session, 1.19 ± 0.45 in the method of increasing blood flow and 1.07 ± 0.35 in the stepwise profile of dialysis fluid flow, and there was a significant difference between the mean score of dialysis adequacy in routine session and each method of increasing blood flow and stepwise profiles of dialysis fluid flow using paired t-test (p=0.001). The results from Cochran statistical test showed that there is a significant difference between the routine methods, an increase in blood flow, stepwise profile of dialysis fluid flow profile in terms of the frequency of muscle cramp during hemodialysis (p<0.05) and this difference was statistically significant between the routine session and an increase in blood flow based on McNemar test (p=0.021). Based on the McNamar statistical test, the difference in headache frequency during hemodialysis was significant between the routine session and the stepwise profile of fluid flow (p=0.039). Conclusion: Although the increase in blood flow and dialysis fluid flow in the stepwise method leads to an increase in the adequacy of dialysis, but they are not safe due to their complications and side effects.

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Citations
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20 Mar 2012
TL;DR: According to DOQI guidelines, minimum dialysis dose by KT/V in patients under hemodialysis (HD) is 1.2 or greater as discussed by the authors, but most patients with ESRD need adequate dialysis.
Abstract: Background and Objective: Patients with ESRD need adequate dialysis. According to DOQI guidelines, minimum dialysis dose by KT/V in patients under hemodialysis (HD) is 1.2 or greater. Subjects and Methods: In a cross- sectional study, we evaluated the value of KT/V among HD patients in shahid Beheshti Hospital of Abadan, Iran. HD was performed for 3 to 4 hours, using synthetic dialyzer and the bicarbonate- based dialysate. Blood flow rate, dialysate flow rate and ultrafiltration rate were 250 to 300 cc /min, 500cc/min and zero or 1 to 3 liters, respectively. Blood sampling for BUN was done immediately before and after the dialysis session. We used the following equation to estimate the KT/V from the percent reduction in urea (PRU). KT/V = (0.026 ×PRU) – 0.460 Results: 54 HD patients (28 females and 26 males) with the mean age of 39 ± 14.2 years were enrolled in the study. The most common cause of ESRD was hypertension (24.07%) followed by, unknown (22.22%), DM (18.51%), Chronic Glomerulonephritis (14.81%), urinary tract abstraction (12.96%) and poly cystic kidney disease (7.40%). KT/V was less than 1.2 in 87.03 patients (n=47). There was no significant difference in the valve of KT/V in men and women (P= 0.54) and in different hemoglobin concentration (p=0.58). Conclusion: The results of the study show that the most of our HD patients have not received minimum dialysis dose and we should evaluate and correct its causes.

6 citations

Journal Article
TL;DR: It is demonstrated that a faster dialysate flow rate increases the efficiency of clearance of Cr,BUN,PTH and β2-MG from blood to dialysates in on-line hemodiafiltration.
Abstract: Objective To evaluate the influence of different dialysate flow rates upon dialysis efficiency in patients receiving on-line maintenance hemodiafiltration.Methods In this clinical trial,different dialysate flow rates(550 ml/min,650 ml/min and 750 ml/min) were respectively given to 32 patients who were treated by on-line maintenance hemodiafiltration.Plasma creatine(CREA),blood urea nitrogen(BUN),parathyroid hormone(PTH) and β2-microglobulin(β2-MG) were examined before and after dialysis to evaluate dialysis efficiency.Results When the dialysate flow rate elevated from 550 to 650 ml/min,the clearance rates of CREA,BUN,PTH and KT/V was increased,though the difference was statistically insignificant(t values were 0.97,0.95,0.130 and 1.64 respectively,P0.05).However,the ascending trend of serum β2-MG clearance rates was statistically significant(t=3.45,P0.05).Statistically significant increased in CREA,BUN,PTH β2-MG clearance rate and KT/V was noted as the dialysate flow rate increased from 550 to 750 ml/min(t values were 3.45,2.79,3.32,4.73 and 3.04,P0.05).Therefore,serum clearance rates of CREA,BUN,PTH,β2-MG and KT/V were unchanged from 650 ml/min to 750 ml/min(t values were 1.32,1.87,2.01,0.49 and 1.63,P0.05).Conclusions The present results demonstrate that a faster dialysate flow rate increases the efficiency of clearance of Cr,BUN,PTH and β2-MG from blood to dialysate in on-line hemodiafiltration.

1 citations

DOI
09 Apr 2021
TL;DR: In this paper, an evidence implementation project was presented to identify the barriers and omissions affecting adequacy of hemodialysis and to develop implementable strategies to maintain he-modalysis adequacy among patients with end-stage renal disease.
Abstract: Objective The aim of this evidence implementation project was to identify the barriers and omissions affecting adequacy of hemodialysis and to develop implementable strategies to maintain hemodialysis adequacy among hemodialysis patients with end-stage renal disease. Introduction Assessing adequacy of hemodialysis and improving quality of life are important issues for patients with end-stage renal disease. However, they are often inadequately addressed, and evidence-based practices are not always followed. Methods A clinical audit was undertaken using the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice approaches. Seven audit criteria that represent best practice recommendations for maintaining hemodialysis adequacy among hemodialysis patients were used. A baseline audit was performed, which was followed by the implementation of multiple improvement strategies over 20 weeks and the outcomes finalized using a follow-up audit to determine the change to be implemented in practice. Results The baseline audit results showed that most audit criteria were less than 77% in practice. The compliance rates for nurses who had received education regarding hemodialysis, checking the prescription order for each patient at each session, and using the prescribed dialyzer for every session were determined to have reached 100% at the follow-up audit. The compliance rates for completion prehemodialysis checks, using a sterile technique when inserting an arteriovenous catheter, matching a blood flow rate with the prescription, and maintaining a blood flow rate throughout the treatment session were found to be 73-95% at the follow-up audit. The most significant finding was the proportion of hemodialysis patients with inadequate urea reduction ratio was reduced from 4.6 to 3.2% after implementation of the best practice approaches. Conclusion The implementation of institution-specific evidence-based resources brought about immediate improvements in hemodialysis adequacy management and practice. A variety of strategies contributed to the success of this implementation project, such as scenario simulation education, Objective Structured Clinical Examination, the interrelation response system Kahoot, the use of hemodialysis International Organization for Standardization job descriptions, regular weekly audits, and collaboration with physicians when caring for patients during clinical practice.
References
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Journal ArticleDOI
TL;DR: It is shown that increasing the dialysate flow rate increases urea K(o)A during clinical dialysis, which is less than that previously reported in vitro (14.7%), possibly because of the impact of blood cells and proteins on blood-side mass transfer resistance.

72 citations


"A comparison of adequacy and compli..." refers background or result in this paper

  • ...Studies by Yan, Frank, Ward and Hauk [10-13] also show that increased fluid flow of dialysis can increase dialysis adequacy....

    [...]

  • ...The results of this study show that each of the methods of increasing blood flow rate, increasing fluid flow of dialysis (stepwise profiles) can effectively increase the adequacy of dialysis, while studies by Albalt and Ward showed that increase in fluid flow is not appropriate to increase dialysis adequacy [15,16], and a study by Asef also states that increasing fluid flow in dialysis improves the efficiency of clearance, not increasing blood flow rate [12]....

    [...]

Journal ArticleDOI
TL;DR: Dialytic clearance of protein-bound solutes can be increased by increasing K(o)A and Q(d) to greater than conventional levels, and a longer term study would be required to determine whether increased dialyticclearance of bound solutes leads to a decrease in plasma solute levels.

69 citations


"A comparison of adequacy and compli..." refers background in this paper

  • ...Studies by Yan, Frank, Ward and Hauk [10-13] also show that increased fluid flow of dialysis can increase dialysis adequacy....

    [...]

Journal ArticleDOI
TL;DR: In vivo the effects of various Qds on the delivered dose of dialysis in 23 maintenance hemodialysis patients were studied and it was concluded that increasing Qd from 500 to 800 mL/min is associated with a significant increase in Kt/V.

63 citations


"A comparison of adequacy and compli..." refers background in this paper

  • ...Studies by Yan, Frank, Ward and Hauk [10-13] also show that increased fluid flow of dialysis can increase dialysis adequacy....

    [...]

Journal ArticleDOI
TL;DR: Investigating the dependence of KoA for urea, phosphate and β2-microglobulin on dialysate flow rate in dialyzers containing undulating fibers to promote flow distribution and two different fiber packing densities found that increasing dialyzer flow rate had no significant effect on KoA or Ko for any of the three solutes examined.
Abstract: Background. Diffusive clearance depends on blood and dialysate flow rates and the overall mass transfer area coefficient (KoA) of the dialyzer. Although KoA should be constant for a given dialyzer, urea KoA has been reported to vary with dialysate flow rate possibly because of improvements in flow distribution. This study examined the dependence of KoA for urea, phosphate and β2-microglobulin on dialysate flow rate in dialyzers containing undulating fibers to promote flow distribution and two different fiber packing densities. Methods. Twelve stable haemodialysis patients underwent dialysis with four different dialyzers, each used with a blood flow rate of 400 mL/min and dialysate flow rates of 350, 500 and 800 mL/min. Clearances of urea, phosphate and β2-microglobulin were measured and KoA values calculated. Results. Clearances of urea and phosphate, but not β2-microglobulin, increased significantly with increasing dialysate flow rate. However, increasing dialysate flow rate had no significant effect on KoA or Ko for any of the three solutes examined, although Ko for urea and phosphate increased significantly as the average flow velocity in the dialysate compartment increased. Conclusions. For dialyzers with features that promote good dialysate flow distribution, increasing dialysate flow rate beyond 600 mL/min at a blood flow rate of 400 mL/min is likely to have only a modest impact on dialyzer performance, limited to the theoretical increase predicted for a constant KoA.

62 citations


"A comparison of adequacy and compli..." refers background in this paper

  • ...Studies by Sun, Yan and Behimani also showed an increase in the adequacy of dialysis with increasing fluid rate of dialysis [9,10,29]....

    [...]

Journal Article
TL;DR: The data confirm that increasing the blood flow rate by 25% is effective in increasing dialysis adequacy in HD patients, and showed a significant difference in dialysis efficiency between two groups.
Abstract: Inadequacy of dialysis is one of the determinants of morbidity and mortality in patients undergoing dialysis. The aim of this study was to assess the effect of increasing blood flow rate during hemodialysis (HD) on the adequacy of dialysis. In this study, 42 patients on maintenance HD were assessed. Body weight and blood urea nitrogen (BUN) levels before and after HD sessions were recorded on all the study patients. Volume of ultrafiltration, the duration of dialysis, percentage of filter clearance and flow rate of the dialysate were collected and documented in a checklist. Both Kt/V and urea reduction ratio (URR) were determined at two different blood pump speeds, i.e. 200 and 250 mL/min. During HD, hemodynamic status and vital signs of patients were monitored and controlled. After collecting the necessary data, efficiency of dialysis was calculated using the standard formula. Descriptive and analytical statistics was carried out to analyze the data. Using blood flow rate of 200 mL/min, 16.7% of patients had Kt/V higher than 1.3 and URR higher than 65. On the other hand, with flow rate of 250 mL/min, 26.2% of patients had Kt/V higher than 1.3 and 35.7% of subjects had URR higher than 65. Paired t-test with 95% confidence showed a significant difference in dialysis efficiency between two groups. Our data further confirm that increasing the blood flow rate by 25% is effective in increasing dialysis adequacy in HD patients.

58 citations


"A comparison of adequacy and compli..." refers background in this paper

  • ...in their research showed that increased blood flow to 15- 25% of previous blood flow is more effective in achieving dialysis adequacy [6,18,19]....

    [...]