Assessment of Hemodialysis Adequacy and Factors Affecting it in Pediatric Patients Using Single Pool Ю/ Г Equation in Zagazig University

Background: Quantification of the dialysis dose is an essential element in the management of chronic hemodialytic treatment. Urea clearance is used as a marker of dialysis adequacy although urea only represents small readily permeable solutes but it has several advantages over other an uremic toxins. Several factors affect clearance and include the blood flow rate; the dialysate flow rate and the efficiency of the dialyzer. Other indicators of dialysis adequacy include the removal of large solutes as creаtinine, vitamin B12 and B2 microglobulin and control of the extracellular volume and blood pressure. Adequacy of dialysis should be assessed in all patients at least 3 monthly as clinically based assessment has proven unreliable.
Objectives: The aim of this study is to assess hemodialysis adequacy and factors affecting it in pediatric patients in pediatric nephrodialysis unit in Zagazig University.
Methods: This study was carried out in pediatric nephrodialysis unit in Zagazig University. It included 30 patients with chronic renal failure on regular hemodialysis. The studied group included 18 females and 12 males. Their ages ranged from 6 to 20 years. They were regularly hemodialysed 3 times weekly and 2 to 4 hours per session by polysulfone membrane using citrate dialysate and their pump rate ranged from 180 to 200 ml/minute. All of them had arteriovenous fistulae. All cases were subjected to detailed history taking, thorough clinical examination and laboratory investigations. Blood urea level pre and post dialysis session using urease colorimetric method was done. Assessment of single pool KdV using the following equation:
Kt/V = 2.2 - 3.3 X (u post/u pre - 0.03 - (w pre — w post)/w post).
Results: We found a significant positive correlation between Kt/V and pump rate, surface area of the dialyzer and duration of dialysis. A highly significant positive correlation was found between Kt/V and dialysis session length and also with serum albumin. No significant correlation was found between Kt/V and other laboratory parameters or blood pressure. The most effective parameter affecting the dialysis efficiency is the dialysis session length.
Conclusion: We conclude that adequate dialysis maximizes well-being, minimizing morbidity, and helps a patient retain social independence. Dialysis prescription should be individualized, monitored, and reassessed regularly. Improving dialysis adequacy as indicated by increased Kt/V can be achieved by increasing dialysis session length, pump rate and the size of the dialyzer.