End Stage Renal Disease
(ESRD) is an irreversible stage of Chronic Renal Failure where Glomerular Filtration
Rate is less than 15 ml per min per 1.73 m2 of surface area. It has
been described as the fifth and the final stage of Chronic Renal Failure by
National Kidney Foundation Kidney Disease Outcome Quality Initiative (NKF-
K/DOQI) 1. An Indian population based studies shows the crude and
age-adjusted ESRD incidence rate averaged around 151 and 232 per million populations
per annum respectively 2.
There are two major
types of Renal Replacement Therapy, available as treatment for ESRD patients –
Kidney transplantation and dialysis 3. Renal transplantation is
beyond the scope of affordability for the middle and lower socio -economic
status patients. Therefore dialysis remains the most widely used treatment
modality. Hemodialysis and peritoneal dialysis are the two major forms of dialysis,
where former is usually preferred over later. Urea is traditionally used as
solute marker for dialysis quantification, because of its small size, readily
dialyzable solute which is a bulk catabolite of protein, easily measurable in
blood and its clearance corresponds to the patient’s mortality. NKF – K/DOQI
considers three methods as appropriate for measuring adequacy of hemodialysis –
Urea Kinetic modelling, Kt/v and Urea Reduction Ratio (URR) 4. Dialysis
adequacy, introduced in 1970’s, refers to the dose of dialysis, which is delivered
to the patients, is considered good enough to promote an ideal long term outcome.
It implies that a patient should have a normal Quality of Life and solid
clinical tolerance with minimum level of problems, during and after a dose of
dialysis 5. Adequacy of hemodialysis is of considerable importance
since it has direct correlation with patient’s mortality. Inadequate
hemodialysis leads to anaemia, malnutrition, functional impairment, frequent
hospitalization and poor patient survival 6. The solute removal can
be drastically augmented by increasing the frequency of hemodialysis session.
Several uncontrolled studies show that there was a significant improvement in
patient –reported outcome and results of laboratory tests when patients were
treated with more frequent hemodialysis 7. The best available
evidences at present indicate an uncertainty regarding the optimal dose of
hemodialysis. So the present study is designed to compare the effectiveness of
three hemodialysis sessions per week with two hemodialysis sessions per week
using URR and Kt/v.
To compare the effectiveness of thrice
weekly hemodialysis with twice weekly hemodialysis by evaluating blood urea, serum
creatinine, URR and Kt/v
To estimate concentration of blood urea
and serum creatinine before and after hemodialysis.