Factors associated with hemodialysis adequacy among end stage renal disease patients on maintenance hemodialysis in Rwanda

  • Authors

    • Didace Ndahayo University of Rwanda, College of Medicine and Health Sciences, School of Nursing and Midwifery, Kigali, Rwanda
    • Emmanuel Bimenyimana Gapira
    • Theos Mbabazi
    • Geldine Chironda
    2021-04-14
    https://doi.org/10.14419/ijans.v10i1.31454
  • End Stage Renal Disease, Hemodialysis Adequacy, Rwanda.
  • Abstract

    The aim of this study was to assess the factors associated with dialysis adequacy in ESRD patients on maintenance hemodialysis in Rwanda. A descriptive cross-sectional study was conducted. A sample size of 66 hemodialysis patients was selected using purposive sampling strategy. An interview scheduled guide was used to collect data. Dialysis adequacy was calculated using kt/v Daugirdas & Schneditz formula. The mean hemodialysis adequacy was 1.26± 0.34. Most participants [41(62%)] had optimal hemodialysis adequacy of equal or greater than to 1.2, 19 (29%) had near optimal hemodialysis adequacy (0.8 - 1.2 kt/v) and only 6 (9%) had less than optimal hemodialysis adequacy (kt/v <0.8). Factors associated with hemodialysis adequacy were hospital settings (p = .010), age (p = .007), BMI (p =.004) and blood pressure level ((p = .018). Moreover, mode of transport and type of drinking water was significantly associated with hemodialysis adequacy (p = 0.032 and 0.030 respectively). In conclusion, the level of hemodialysis adequacy was low in 38% of ESRD patients with associated factors predominantly demographics. Therefore, further research inquiry is needed on additional factors which include technical aspects to establish their association with hemodialysis adequacy.

     

     

  • References

    1. [1] Caravaca-Fontán, F., Azevedo, L., Luna, E. and Caravaca, F., 2017. Patterns of progression of chronic kidney disease at later stages. Clinical kidney journal, 11(2), pp.246-253. https://doi.org/10.1093/ckj/sfx083.

      [2] Chandrashekar,A., Ramakrishnan, S. and Rangarajan, D., 2014.Survival analysis of patients on maintenance hemodialysis. Indian journal of nephrology, 24(4), p.206. https://doi.org/10.4103/0971-4065.132985.

      [3] Chowdhury, T.A., Iqbal, S., Talukder, U.S., Ananna, M.A., Bhuiyan, A.M.M., Billah, M., Rahim, M.A., Samad, T. and Hossain, R.M., 2017. A study on knowledge of patients with end stage renal disease towards dialysis in a tertiary care hospital in Dhaka city. IMC Journal of Medical Science, 11(1), pp.11-14. https://doi.org/10.3329/imcjms.v11i1.31932.

      [4] ElHafeez, S.A., Bolignano, D., D’Arrigo, G., Dounousi, E., Tripepi, G. and Zoccali, C., 2018. Prevalence and burden of chronic kidney disease among the general population and high-risk groups in Africa: a systematic review. BMJ open, 8(1), p.e015069. https://doi.org/10.1136/bmjopen-2016-015069.

      [5] Etheredge, H. and Fabian, J., 2017, September. Challenges in expanding access to dialysis in South Africa—expensive modalities, cost constraints and human rights. In Healthcare (Vol. 5, No. 3, p. 38). Multidisciplinary Digital Publishing Institute. https://doi.org/10.3390/healthcare5030038.

      [6] Fernandez-Prado, R., Fernandez-Fernandez, B. and Ortiz, A., 2018. Women and renal replacement therapy in Europe: lower incidence, equal access to transplantation, longer survival than men. Clinical kidney journal, 11(1), pp.1-6. https://doi.org/10.1093/ckj/sfx154.

      [7] George, C., Mogueo, A., Okpechi, I., Echouffo-Tcheugui, J.B. and Kengne, A.P., 2017. Chronic kidney disease in low-income to middle-income countries: the case for increased screening. BMJ global health, 2(2), p.e000256. https://doi.org/10.1136/bmjgh-2016-000256.

      [8] Girndt, M., Trocchi, P., Scheidt-Nave, C., Markau, S. and Stang, A., 2016. The Prevalence of Renal Failure: Results from the German Health Interview and Examination Survey for Adults, 2008–2011 (DEGS1). DeutschesÄrzteblatt International, 113(6), p.85. https://doi.org/10.3238/arztebl.2016.0085.

      [9] Glidewell, L., Boocock, S., Pine, K., Campbell, R., Hackett, J., Gill, S. and Wilkie, M., 2013. Using behavioral theories to optimize shared hemodialysis care: a qualitative intervention development study of patient and professional experience. Implementation Science, 8(1), p.118. https://doi.org/10.1186/1748-5908-8-118.

      [10] Haghighi, M.J., Shahdadi, H., Abdollahimohammad, A. and Moghadam, M.P., 2016. The effect of low-flux and high-flux filters on adequacy and complications during hemodialysis of patients. Der Pharmacia Lettre, 8(19), pp.395-399. https://doi.org/10.1186/s12882-017-0664-9.

      [11] Hauber, B., Caloyeras, J., Posner, J., Brommage, D., Tzivelekis, S. and Pollock, A., 2017. Hemodialysis patients’ preferences for the management of anemia. BMC nephrology, 18(1), p.253 https://doi.org/10.1186/s12882-017-0664-9.

      [12] Hod, T., Patibandla, B.K., Vin, Y., Brown, R.S. and Goldfarb-Rumyantzev, A.S., 2014. Arteriovenous fistula placement in the elderly: when is the optimal time? Journal of the American Society of Nephrology, pp.ASN-2013070740. https://doi.org/10.1681/ASN.2013070740.

      [13] Ibrahim, S., Hossam, M. and Belal, D., 2015. Study of non-compliance among chronic hemodialysis patients and its impact on patients' outcomes. Saudi Journal of Kidney Diseases and Transplantation, 26(2), p.243 https://doi.org/10.4103/1319-2442.152405.

      [14] Iraq. Meyer, T.W., Sirich, T.L., Fong, K.D., Plummer, N.S., Shafi, T., Hwang, S., Banerjee, T., Zhu, Y., Powe, N.R., Hai, X. and Hostetter, T.H., 2016. Kt/Vurea and nonurea small solute levels in the hemodialysis study. Journal of the American Society of Nephrology, pp.ASN-2015091035. https://doi.org/10.1681/ASN.2015091035.

      [15] Jacob, s., 2016. The relationship between hemodialysis patients’ fluid compliance and selected socio-demographic factors in northern alberta, canada (doctoral dissertation, university of northern BritishColumbia https://doi.org/10.24124/2016/1235.

      [16] Jebraeily, M., Safdari, R., Rahimi, B., Makhdoomi, K. and Ghazisaeidi, M., 2018. The application of intelligent information systems in hemodialysis adequacy promotion. Journal of Renal Injury Prevention, 7(2), pp.64-68. https://doi.org/10.15171/jrip.2018.16.

      [17] Jin, D.C., 2015. Major changes and improvements of dialysis therapy in Korea: review of end-stage renal disease registry. The Korean journal of internal medicine, 30(1), p.17. https://doi.org/10.3904/kjim.2015.30.1.17.

      [18] Kramer, A., 2011. Epidemiology and outcomes of renal replacement therapy: results from the ERA-EDTA registry. Universiteit van Amsterdam.[see https://hdl.handle.net/11245/1.385818]

      [19] Kulkarni, M.J., Jamale, T., Hase, N.K., Jagdish, P.K., Keskar, V., Patil, H., Shete, A. and Patil, C., 2015. A cross-sectional study of dialysis practice-patterns in patients with chronic kidney disease on maintenance hemodialysis. Saudi Journal of Kidney Diseases and Transplantation, 26(5), p.1050. https://doi.org/10.4103/1319-2442.164607.

      [20] Lertdumrongluk, P., Streja, E., Rhee, C.M., Park, J., Arah, O.A., Brunelli, S.M., Nissenson, A.R., Gillen, D. and Kalantar-Zadeh, K., 2014. Dose of hemodialysis and survival: a marginal structural model analysis. American journal of nephrology, 39(5), pp.383-391. https://doi.org/10.1159/000362285.

      [21] Liu, F.X., Rutherford, P., Smoyer-Tomic, K., Prichard, S. and Laplante, S., 2015. A global overview of renal registries: a systematic review. BMC nephrology, 16(1), p.31 https://doi.org/10.1186/s12882-015-0028-2.

      [22] Liyanage, T., Ninomiya, T., Jha, V., Neal, B., Patrice, H.M., Okpechi, I., Zhao, M.H., Lv, J., Garg, A.X., Knight, J. and Rodgers, A., 2015. Worldwide access to treatment for end-stage kidney disease: a systematic review. The Lancet, 385(9981), pp.1975-1982. https://doi.org/10.1016/S0140-6736(14)61601-9.

      [23] Lu R, Estremadoyro C, Chen X, Zhu M, Ribeiro LC, Yan Y, Brendolan A, Fang W, Crepaldi C, Ni Z, Gu L. Hemodialysis versus peritoneal dialysis: an observational study in two international centers. The International journal of artificial organs. 2018 Jan;41(1):58-65. https://doi.org/10.5301/ijao.5000656.

      [24] Mimura, I., Tanaka, T. and Nangaku, M., 2015. How the Target Hemoglobin of Renal Anemia Should Be? Nephron, 131(3), pp.202-209. https://doi.org/10.1159/000440849.

      [25] Mukakarangwa, M. C., Chironda, G., Bhengu, B., & Katende, G. (2018). Adherence to hemodialysis and associated factors among end stage renal disease patients at selected nephrology units in rwanda: a descriptive cross-sectional study. Nursing research and practice, 2018. https://doi.org/10.1155/2018/4372716.

      [26] Mushi, L., Marschall, P. and Fleßa, S., 2015. The cost of dialysis in low and middle-income countries: a systematic review. BMC health services research, 15(1), p.506. https://doi.org/10.1186/s12913-015-1166-8.

      [27] Nafar, M., Samavat, S., Khoshdel, A. and Abedi, B.A., 2017. Dialysis Adequacy, Dialyzer Clearance, and Strategies to Achieve Target: A Nationwide Multicenter Study. Nephro-Urology Monthly, 9(1). https://doi.org/10.5812/numonthly.42769.

      [28] Naicker, S. and Ashuntantang, G., 2017. End stage renal disease in Sub-Saharan Africa. In Chronic Kidney Disease in Disadvantaged Populations (pp. 125-137). https://doi.org/10.1016/B978-0-12-804311-0.00014-5.

      [29] Naicker, S. and Ashuntantang, G., 2017. End stage renal disease in Sub-Saharan Africa. In Chronic Kidney Disease in Disadvantaged Populations (pp. 125-137). https://doi.org/10.1016/B978-0-12-804311-0.00014-5.

      [30] Oluyombo, R., Okunola, O.O., Olanrewaju, T.O., Soje, M.O., Obajolowo, O.O. and Ayorinde, M.A., 2014. Challenges of hemodialysis in a new renal care center: call for sustainability and improved outcome. International journal of nephrology and renovascular disease, 7, p.347. https://doi.org/10.2147/IJNRD.S65835.

      [31] Paiva, C.E., Barroso, E.M., Carneseca, E.C., de Pádua Souza, C., dos Santos, F.T., López, R.V.M. and Paiva, S.B.R., 2014. A critical analysis of test-retest reliability in instrument validation studies of cancer patients under palliative care: a systematic review. BMC medical research methodology, 14(1), p.8. https://doi.org/10.1186/1471-2288-14-8.

      [32] Rees, L., 2018. Assessment of dialysis adequacy: beyond urea kinetic measurements. Pediatric Nephrology, pp.1-9. https://doi.org/10.1007/s00467-018-3914-6.

      [33] Rezaiee, O., Shahgholian, N. and Shahidi, S., 2016. Assessment of hemodialysis adequacy and its relationship with individual and personal factors. Iranian journal of nursing and midwifery research, 21(6), p.577 https://doi.org/10.4103/1735-9066.197673.

      [34] Ross, E.A., Paugh-Miller, J.L. and Nappo, R.W., 2017. Interventions to improve hemodialysis adequacy: protocols based on real-time monitoring of dialysate solute clearance. Clinical Kidney Journal, 11(3), pp.394-399. https://doi.org/10.1093/ckj/sfx110.

      [35] Saleh, T., Sumida, K., Molnar, M.Z., Potukuchi, P.K., Thomas, F., Lu, J.L., Gyamlani, G.G., Streja, E., Kalantar-Zadeh, K. and Kovesdy, C.P., 2017. Effect of age on the Association of Vascular Access Type with mortality in a cohort of incident end-stage renal disease patients. Nephron, 137(1), pp.57-63. https://doi.org/10.1159/000477271.

      [36] Santoro, D., Benedetto, F., Mondello, P., Pipitò, N., Barillà , D., Spinelli, F., Ricciardi, C.A., Cernaro, V. and Buemi, M., 2014. Vascular access for hemodialysis: current https://doi.org/10.2147/IJNRD.S46643.

      [37] Shahdadi, H., Balouchi, A., Sepehri, Z., Rafiemanesh, H., Magbri, A., Keikhaie, F., Shahakzehi, A. and Sarjou, A.A., 2016. Factors Affecting Hemodialysis Adequacy in Cohort of Iranian Patient with End Stage Renal Disease. Global journal of health science, 8(8), p.50. https://doi.org/10.5539/gjhs.v8n8p50.

      [38] Sharif, D.A., Awn, A.H., Murad, K.M. and Meran, I.M., Demographic and Characteristic Distribution of End Stage Renal Failure in Sulaimani Governorate, Kurdistan Region,

      [39] Shibiru, T., Gudina, E. K., Habte, B., Deribew, A., & Agonafer, T. (2013). Survival patterns of patients on maintenance hemodialysis for end stage renal disease in Ethiopia: summary of 91 cases. BMC nephrology, 14(1), 1-6. https://doi.org/10.1186/1471-2369-14-127.

      [40] Slinin, Y., Greer, N., Ishani, A., MacDonald, R., Olson, C., Rutks, I. and Wilt, T.J., 2015. Timing of dialysis initiation, duration and frequency of hemodialysis sessions, and membrane flux: a systematic review for a KDOQI clinical practice guideline. American Journal of Kidney Diseases, 66(5), pp.823-836. https://doi.org/10.1053/j.ajkd.2014.11.031.

      [41] Sun, Y., Wang, Y., Yu, W., Zhuo, Y., Yuan, Q. and Wu, X., 2018. Association of Dose and Frequency on the Survival of Patients on Maintenance of Hemodialysis in China: A Kaplan-Meier and Cox-Proportional Hazard Model Analysis. Medical science monitor: international medical journal of experimental and clinical research, 24, p.5329. https://doi.org/10.12659/MSM.909404.

      [42] Tsai, W.C., Wu, H.Y., Peng, Y.S., Ko, M.J., Wu, M.S., Hung, K.Y., Wu, K.D., Chu, T.S. and Chien, K.L., 2016. Risk factors for development and progression of chronic kidney disease: a systematic review and exploratory meta-analysis. Medicine, 95(11). https://doi.org/10.1097/MD.0000000000003013.

      [43] Wright, D.G., Wright, E.C., Narva, A.S., Noguchi, C.T. and Eggers, P.W., 2015. Association of erythropoietin dose and route of administration with clinical outcomes for patients on hemodialysis in the United States. Clinical Journal of the American Society of Nephrology, pp.CJN-01590215 https://doi.org/10.2215/CJN.01590215.

      [44] Younis, M., Jabr, S., Al-Khatib, A., Forgione, D., Hartmann, M. and Kisa, A., 2015. A cost analysis of kidney replacement therapy options in Palestine. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 52, p.0046958015573494 https://doi.org/10.1177/0046958015573494.

      [45] Youssouf, S., 2017. Outcomes of a Programme of Quality Improvement to Improve Attainment of Clinical Indicators in a Chronic Dialysis Population (Doctoral dissertation, University of Manchester).

      [46] Zhang, M., Wang, M., Li, H., Yu, P., Yuan, L., Hao, C., Chen, J. and Kalantar-Zadeh, K., 2014. Association of initial twice-weekly hemodialysis treatment with preservation of residual kidney function in ESRD patients. American journal of nephrology, 40(2), pp.140-150 https://doi.org/10.1159/000365819.

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  • How to Cite

    Ndahayo, D., Bimenyimana Gapira, E., Mbabazi, T., & Chironda, G. (2021). Factors associated with hemodialysis adequacy among end stage renal disease patients on maintenance hemodialysis in Rwanda. International Journal of Advanced Nursing Studies, 10(1), 9-18. https://doi.org/10.14419/ijans.v10i1.31454

    Received date: 2021-02-19

    Accepted date: 2021-03-19

    Published date: 2021-04-14