Prevalence and Predictors of Hemodialysis Inadequacy among Patients on Maintenance Hemodialysis in Mwanza, Tanzania

Abstract

Introduction: The burden of chronic kidney disease (CKD) is rapidly increasing in Tanzania. There is a rapid expansion of hemodialysis (HD) services to meet this demand. The quality of HD services, which is usually termed HD inadequacy, is under-reported. Therefore, the objective of this study was to determine the prevalence of HD inadequacy using two equations, urea reduction ratio (URR) and Kt/V and its associated factors. The correlation between URR and Kt/V for the diagnosis of HD inadequacy is also determined. Materials and Methods: This was a prospective longitudinal study conducted from March to July 2021 in 98 patients with CKD who underwent maintenance HD at Bugando Medical Centre in Mwanza, Tanzania. Demographic, laboratory, and clinical information was collected and analyzed. The HD inadequacy was estimated by using both the URR and the Kt/V equations. The correlation between the two equations was analyzed by using Cohen’s kappa. Results: The majority (69.4%) of the study participants were male and the mean age was 59 (48 - 68) years. The median hemoglobin level was 10 (8.9 - 11.2) g/dl, and the pre-dialytic urea was 15 (10.6 - 21.3) mmol/L. The prevalence of HD inadequacy was 36 (36.7%). The predictors of HD inadequacy were older age (>50 years) (OR = 3.6, 95 % CI 1.0 - 12.6, p = 0.04), moderate or severe anemia (OR = 4.7, 95 % CI 1.5 - 14.4, p = 0.006) and short duration of HD (OR = 3.1, 95 % CI 1.0 - 9.1, p = 0.04). There was a strong agreement between URR and Kt/V in the diagnosis of HD inadequacy (Kappa = 0.887). Conclusion and Recommendations: HD inadequacy is common, and most predictors can be prevented. Clinicians should use a personalized approach in making sure that anemia is appropriately treated and HD prescription is adhered to for better clinical outcomes among patients with HD.