Somji Samina S, Ruggajo Pascal, Moledina Sibtain
Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania.
Int J Nephrol. 2020 Feb 10;2020:9863065. doi: 10.1155/2020/9863065. eCollection 2020.
The worldwide prevalence of maintenance hemodialysis continues to rise. An adequate delivery of hemodialysis dose as measured by / or urea reduction ratio is a crucial determinant of clinical outcome for chronic hemodialysis patients. The aim of this study was to assess the adequacy of hemodialysis and its associated factors among patients undergoing chronic hemodialysis in Dar es Salaam. This was a cross-sectional study done on patients undergoing chronic hemodialysis in four dialysis centers in Dar es Salaam. Sociodemographic information and treatment characteristics were collected. Urea reduction rate and single-pool / were calculated to determine the adequacy of hemodialysis. The data were analyzed and any associated factors for inadequate hemodialysis were determined using a chi-square test and a logistic regression analysis. A total of 143 patients participated in the study. Males represented 65.7% of the study population. The mean age (±SD) was 51.7 ± 1.2 years. Only 34.3% (based on urea reduction ratio (URR)) and 40.6% (based on /) of patients received adequate hemodialysis. The univariate analysis showed that males were more likely to have inadequate dialysis (65.6% versus 48.0%, =0.048 based on /). Patients using hemodialyzers with dialyzer surface area less than 1.4 m received significantly less hemodialysis dose than those with more than 1.4 m (69.0% versus 41.2%, =0.02, by URR) (62.7% versus 35.3%, =0.03, by / criteria). Patients who had hemoglobin <10 g/dl received significantly inadequate hemodialysis dose as compared to patients with hemoglobin ≥10 g/dl by / criteria (69.8% versus 51.3%, =0.03). None of the factors acquired significance in the multivariate analysis. The proportion of patients receiving an adequate hemodialysis dose is low (34.3% based on URR and 40.6% based on /). Male gender, dialyzer surface area of <1.4 m, and hemoglobin level of <10 g/dl were associated with an inadequate delivered dose of hemodialysis in the univariate analysis but not in the multivariate analysis. This study can increase awareness about the importance of measuring hemodialysis adequacy and giving the correct hemodialysis dose to achieve the intended benefit.
维持性血液透析在全球的患病率持续上升。通过尿素清除率或尿素下降率衡量的充分的血液透析剂量是慢性血液透析患者临床结局的关键决定因素。本研究的目的是评估达累斯萨拉姆慢性血液透析患者的血液透析充分性及其相关因素。这是一项对达累斯萨拉姆四个透析中心的慢性血液透析患者进行的横断面研究。收集了社会人口学信息和治疗特征。计算尿素清除率和单池Kt/V来确定血液透析的充分性。对数据进行分析，并使用卡方检验和逻辑回归分析确定血液透析不充分的任何相关因素。共有143名患者参与了该研究。男性占研究人群的65.7%。平均年龄（±标准差）为51.7±1.2岁。仅34.3%（基于尿素下降率（URR））和40.6%（基于Kt/V）的患者接受了充分的血液透析。单因素分析显示，男性更有可能透析不充分（基于Kt/V，分别为65.6%对48.0%，P = 0.048）。使用透析器表面积小于1.4平方米的血液透析器的患者比使用大于1.4平方米的患者接受的血液透析剂量显著更少（基于URR，分别为69.0%对41.2%，P = 0.02）（基于Kt/V标准，分别为62.7%对35.3%，P = 0.03）。血红蛋白<10g/dl的患者与血红蛋白≥10g/dl的患者相比，基于Kt/V标准接受的血液透析剂量显著不足（分别为69.8%对51.3%，P = 0.03）。在多因素分析中，这些因素均无显著意义。接受充分血液透析剂量的患者比例较低（基于URR为34.3%，基于Kt/V为40.6%）。在单因素分析中，男性、透析器表面积<1.4平方米和血红蛋白水平<10g/dl与血液透析剂量不足有关，但在多因素分析中并非如此。本研究可以提高对测量血液透析充分性以及给予正确血液透析剂量以实现预期益处的重要性的认识。
