Under-Dialysis: Determinants and clinical correlates – Findings from a two-centre retrospective study in Nigeria

Background: To deliver an adequate dialysis dose, it is necessary that the dialysis frequency, erythropoietin use, blood pressure control among others, be optimized. This is in addition to treating comorbidities and minimizing complications. Adequate dialysis improves the quality of life (QOL) and reduces the morbidity and mortality rates. Aim: To assess the determinant and correlates of under-dialysis in these two centres. Materials and Methods: We analyzed 5065 prevalent dialysis treatments given to 623 participants with end-stage renal disease from two centres in Nigeria. Participants' biodata, serum biochemistry, and hematocrit of cohorts with once-, twice-, and thrice-weekly sessions were analyzed. Results: Males had more dialysis treatments than women. Two hundred and twenty-seven (36.4%) cohorts had weekly sessions, 296 (47.5%) had twice-weekly sessions, and 100 (16.1%) had thrice-weekly sessions. The mean age of all participants was 50.5 ± 7.9 years, and was higher in women than men, P = 0.02. The percentage of the elderly in the maintenance dialysis population was 13.8%. Only 19.4% of the participants meet the Kidney Disease Outcomes Quality Initiative recommendation of thrice-weekly erythropoietin, just as only 11.9% had health insurance. The dialysis dose was higher in males (P = 0.07), with health insurance (P < 0.001), frequent dialysis (P < 0.001), frequent erythropoietin (P < 0.001), higher hematocrit (P = 0.03), and bicarbonate (P = 0.001), but was lower in intradialytic hypotension compared to intradialytic hypertension, P = 0.004 versus P = 0.005. Dialysis termination and intradialytic death were negatively correlated with dialysis frequency. Health insurance, frequency of dialysis, and erythropoietin predicted the dialysis dose. Conclusion: Under-dialysis and suboptimal erythropoietin use were prevalent in the dialysis population and it restricted the prescribed dose which eventually gave lower dialysis doses, higher dialysis complications, and poor QOL.