Assessment of Adequacy of Haemodialysis in Patients on Maintenance Haemodialysis: A Descriptive Observational Study

Abstract

Background: Haemodialysis (HD) is the most common form of Renal Replacement Therapy (RRT) used for End Stage Renal Disease (ESRD). The adequacy of haemodialysis, assessed through Kt/V and Urea Reduction Ratio (URR), is a critical determinant of patient morbidity and mortality, yet many Indian centres fail to achieve recommended targets. Objective: To assess the adequacy of haemodialysis in patients on maintenance haemodialysis using Kt/V and URR, and to study haemoglobin levels, blood pressure control, and intradialytic complications in this population. Methods: A hospital-based descriptive observational study was conducted over one year. Thirty-five End Stage Renal Disease patients on maintenance haemodialysis for more than six months were enrolled, and 420 dialysis sessions were monitored. Pre- and post-dialysis blood urea, haemoglobin, and blood pressure were recorded monthly. Kt/V was calculated using the Daugirdas second-generation formula, and URR was calculated from pre- and post-dialysis blood urea nitrogen values. Results: The mean age of participants was 55.63 ± 15.06 years, with 65.71% males. Diabetes mellitus (54.28%) and hypertension (48.57%) were the leading causes of ESRD. The mean Kt/V across all sessions was 1.118 ± 0.20, with only 144 (34.29%) sessions achieving the target Kt/V ≥1.2. The mean URR was 59.93 ± 7.08%, with only 106 (25.24%) sessions reaching the target URR ≥65%. Both targets were simultaneously met in only 105 (25%) sessions. Mean haemoglobin was 10.86 ± 1.92 g/dL. Intradialytic hypotension occurred in 37.14% and muscle cramps in 31.42% of participants. Kt/V and URR showed a strong positive correlation (r = 0.935, p = 0.0001). Conclusion: A majority of haemodialysis sessions in this cohort were inadequate by recommended standards, highlighting the need for stricter monitoring, patient education, and adherence to prescribed dialysis duration to reduce morbidity in ESRD patients.