Adequacy of haemodialysis in two centres in Southwestern Nigeria: Determinants and clinical correlates

Abstract

Background: Dialysis remains the most common modality of renal replacement therapy for managing end-stage kidney disease. Optimisation of various measures is needed for its efficient delivery. Inadequate dialysis is common in many low-income nations, and there could be inter-centre differences in the delivered dose. Aim: We assessed the dialysis adequacy and factors associated with inter-centre variation. Materials and Methods: This was a two-centre comparative study. Participants' sociodemographic and examination findings were documented and dialysis was prescribed. Pre- and post-dialysis blood for electrolytes, urea and creatinine were taken, and urea reduction ratio and fractional urea clearance as a function of its distribution volume (Kt/V) were calculated. Results: Two hundred and thirty-two participants had 1248 dialysis sessions. Participants' mean age was 49.9 ± 4.6 years. More males participated in the study, and males also received more sessions per participant. A greater proportion of the participants had tertiary education and had hypertensive nephropathy as the cause of kidney disease. The internal jugular access was used for dialysis in majority (60.6%) of the dialysis sessions. Dialysis dose (DD) was adequate in only 115 (9.2%) sessions. The mean DD was 1.02 ± 0.4; in the two centres, it was 0.86 ± 0.2 and 1.11 ± 0.5. Conclusion: DD is low in many low-income nations including Nigeria. The DD was directly related to the blood flow rate, dialysis duration and frequency of erythropoietin use. In addition to other factors, inability to afford prescribed dialysis regimen is a major contributor to the low DD in low-income settings.