Haemodialysis Adequacy: Ultraviolet vs. Calculated Methods

Muhammad Anees; Noman Butt; Irfan Elahi; Muhammad Shahbaz Pervaiz; Faiqa Saeed Butt

doi:10.29271/jcpsp.2025.05.596

Author(s)

Muhammad Anees Department of Nephrology, King Edward Medical University,Lahore,Pakistan

Noman Butt Department of Nephrology, Sargodha Medical College, Dr. Faisal Masood Teaching Hospital,Sargodha,Pakistan

Irfan Elahi Department of Nephrology, King Edward Medical University,Lahore,Pakistan

Muhammad Shahbaz Pervaiz Department of Nephrology, Mayo Hospital, King Edward Medical University,Lahore,Pakistan

Faiqa Saeed Butt Department of Nephrology, Mayo Hospital, King Edward Medical University,Lahore,Pakistan

Abstract

To compare measuring methods of haemodialysis adequacy; realtime urea reduction ratio (RT-URR) and realtime Kt/V (RTKt/V) with calculated urea reduction ratio (C-URR) and calculated Kt/V (C-Kt/V), respectively, in end-stage kidney disease (ESKD) patients. Study Design: Cross-sectional prospective study. Place and Duration of the Study: Department of Nephrology, Mayo Hospital, King Edward Medical University, Lahore, Pakistan, from July to December 2023. Methodology: Patients on maintenance haemodialysis for more than 3 monvtihas a well-functioning arteriovenous stula were included, while patients with acute kidney injury and dialysis-related complications were excluded. Pre- and post-dialysis blood samples for urea measurement were sent to the laboratory. RT-URR and RT-Kt/V were measured by the NIKKISO-DBB-EXAES machine using the ultraviolet absorbance method on spent dialysate. By putting pre- and post-dialysis, urea values C-URR and C-Kt/V (Daugirdas formula) were calculated. RT-URR, C-URR, RT-Kt/V and C-Kt/V were analysed for correlation using the Bland-Altman graph. Results: Fifty patients were included, with a mean age of 45.18 ± 12.25 years. The majority (n = 29, 58%) were male. Major cause of ESKD was hypertension (n = 27, 54%), followed by diabetes mellitus (n = 16, 32%). The mean duration of dialysis was 54.16 ± 31.74 months, and the majority of patients, 29 (58%), were on thrice weekly dialysis. A positive statistically signi cant correlation was found between C-URR and C-Kt/V with RT-URR and RT-Kt/V, respectively (p <0.001). A signi cant negative correlation was found for body surface area (BSA) with C-URR (p <0.001) and RT-URR (p = 0.013). Also, a signi cant negative correlation of BSA with C-Kt/V (p <0.001) and RT-Kt/V (p = 0.008) was found. Conclusion: RT-URR and RT-Kt/V, being strongly correlated with C-URR and C-Kt/V, can precisely tell about adequacy of haemodialysis.

Publication Details

Page(s) 596-600

DOI 10.29271/jcpsp.2025.05.596

Published Journal: Journal of the College of Physicians and Surgeons Pakistan, Volume: 35, Issue: 05, Year: 2025

Request the full text from PASTIC

Keywords

Urea, Haemodialysis, Home, Renal dialysis, Ultraviolet rays, Haemodialysis solutions

References

Somji SS,Ruggajo P,Moledina S. .2020 .Adequacy of haemodialysis and its associated factors among patients undergoing chronic haemodialysis in dares Salaam, Tanzania. Int J Nephrol2020, 10 : .

Suparti S,Sodikin S,Endiyono E. .2020 .The relationship between dialysis adequacy and fatigue in patients on maintenance haemodialysis. J Keper Pad, 10(1) : 1165-8.

Barzegar H,Moosazadeh M,Jafari H,Esmaeili R .2016 .Evaluation of dialysis adequacy in haemodialysis patients: A systematic review. Urol J, 10(4) : 3314-9.

Liang KV,Zhang JH,Palevsky PM .2019 .Urea reduction ratio may be a simpler approach for measurement of adequacy of intermittent haemodialysis in acute kidney injury. BMC Nephrol, 10 : 1-7.

Kidney National .2015 .KDOQI clinical practice guideline for haemodialysis adequacy: 2015 update. Am J Kidney Dis, 07(5) : 884-930.

Mactier R,Hoenich N,Breen C .2011 .Renal association clinical practice guideline on haemodialysis. Nephron Clin Pract, 10(Suppl 1) : c241-86.

AlSahow A,Muenz D,Al-Ghonaim MA,Al Salmi I,Hassan M,Al Aradi AH .2021 .Kt/V: achievement, predictors and relationship to mortality in haemodialysis patients in the Gulf Cooperation Council countries: Results from DOPPS (. Clin Kidney J, 10(3) : 820-30.

Esmaili H,Majlessi F,Montazeri A,Sadeghi R,Nedjat S,Zeinali J .2018 .Dialysis adequacy and necessity of implement health education models to its promotion in Iran. Int J Med Res Health Sci, 5(10) : 116-21.

Mateen FE,Ahmad S,Elahi I,Anees M .2022 .Comparison between di erent methods of calculating Kt/V as the marker of adequacy of dialysis. doi: 10.12669%2Fpjms.38.1, 38(1) : 167.

Mansur A,Saleem S,Mahmood A,Rasool Z .2020 .Assessment of haemodialysis adequacy: correlation between online clearance monitoring and single pool Kt/V. Professional Med J. , 10(11) : .

Daugirdas JT .1993 .Second generation logarithmic estimates of single-pool variable volume Kt/V: An analysis of error. J Am Soc Nephrol, 1205(5) : 1205-13.

Marrocos MS,Castro CN,Barbosa WA,Sizo AM,Rodrigues FT,Lima RA .2020 .Comparison of dialysis dose through real-time Kt/V by ultraviolet absorbance of spent dialysate, single-pool Daugirdas II, and Kt/BSA according to gender and age. Braz J Nephrol, 10(1) : 2175-60.

.1991 .The urea reduction ratio (URR): A simple method for evaluating haemodialysis treatment. Contemp Dial Nephrol, 12 : 11-20.

Collins AJ .2003 .Cardiovascular mortality in end-stage renal disease. Am J Med Sci, 10(4) : 00000441-7.

Steyaert S,Holvoet E,Nagler E,Malfait S,Van Biesen W. .2019 .Reporting of dialysis adequacy as an outcome in randomised trials conducted in adults on haemodialysis. PLoS One, 0207045(2) : .

Gotch FA,Sargent JA. .1985 .A mechanistic analysis of the national cooperative dialysis study (NCDS). Kidney Int, 160(3) : 526-34.

Bharati J,Jha V .2020 .Achieving dialysis adequacy: A global perspective. Seminars in Dialysis, 10(6) : 490-8.

Baloglu I,Selcuk NY,Evran H,Tonbul HZ,Turkmen K .2019 .Evaluation of haemodialysis adequacy: Correlation between Kt/V. Turk J Nephrol. , 3426(3) : 193-6.

Fridolin I,Magnusson M,Lindberg LG .2001 .Measurement of solutes in dialysate using UV absorption. Opt Diagnostics Sens Biol Fluids Glucose Cholest Monit, 2 : 40-7.

Yang Y,Chen J,Wang W,Zhang YM,Li WG .2020 .A novel method to rapidly calculate the urea clearance index and urea reduction rate based on parameters obtained during haemodialysis. Chronic Dis Transl Med, 11(1) : 41-6.

Raimann JG,Ye X,Kotanko P,Daugirdas JT .2019 .Routine Kt/V and normalized protein nitrogen appearance rate determined from conductivity access clearance with infrequent postdialysis serum urea nitrogen measurements. Am J Kidney Dis, 12(1) : 22-31.