Introduction:
Chronic kidney disease (CKD) is a major public health problem affecting 8–16% of adults globally.1 Untreated CKD can progress rapidly to end-stage renal disease (ESRD).Declines in kidney function are typically associated with rises in blood pressure, and sustained elevations in BP hasten the progression of kidney function decline. Due to the dramatic increase in the need for RRT in recent decades and the upward trend and owing to the shortage of kidneys for transplantation and complications of peritoneal dialysis, hemodialysis is the most common method of them.
Methods:
1. STUDY SETTING:
This study is a hospital based study (in and out patients), Department of Nephrology at Medica Superspecialty Hospital, Kolkata.
2. STUDY DURATION:
This study has been completed within one and half year of time duration (February 2024 to July 2024).
3. STUDY DESIGN:
This study is a prospective cross-sectional observational study.
4. SAMPLE SIZE:
The sample size is calculated in discussion with our statistician using the formula of – n = (Zα/2+Zβ) 2 [p1 (1 – p1) + p2 (1 – p2)] / (p1 – p2)2
Where,
n = Sample Size
Zα/2 = Critical value of Normal distribution at α/2 (here, for a confidence level of 90%, Z value is 1.645)
Zβ = Critical value of Normal distribution at β (here, for a power of 80%, Z value is 0.84) p1 = Proportion of patients having low flux hemodialysis having high BP = 0.56
p2 = Proportion of patients having high flux hemodialysis having high BP = 0.42
From the formula at 90% confidence interval and 80% of power we get the minimum number of observations required are of 155 in each group. For that, 31 patients have been taken for each group and evaluated for 5 hemodialysis sessions for a total of 155 observations in each group.
5.
DATA MANAGEMENT AND STATISTICAL ANALYSIS:
The statistical software SPSS version 23 has been used for the analysis. Kolmogorov- Smirnov analysis has been used to check if data is following the normal distribution. Fischer exact test or Chi-square test has been used to check the significance of difference between frequency distribution of data in different groups. Student’s t test or Mann-Whitney U test has been used to study significance of difference between two groups. z-test has been used for comparison of proportions. Pearson’s rank order correlation analysis and spearman’s correlation analysis has been used to assess correlation between two variables. To assess the difference between three groups ANOVA has been used. p value less than of 0.05 has been considered to be statistically significant.
Results:
It shows that among 62 patients on dialysis, 60% (n=37) are male and 40% (n=25) are female. Among 31 patients on Low flux modality 32% (n=10) are Diabetic nephropathy, 13% (n=4) are Hypertensive nephropathy, 6% (n=2) are Biopsy proven glomerulonephritis/ interstitial nephritis and 48% (n=15) are of unknown cause. Among 31 patients on High flux modality 29% (n=9) are Diabetic nephropathy, 19% (n=6) are Hypertensive nephropathy, 10% (n=3) are Biopsy proven glomerulonephritis / interstitial nephritis and 42% (n=13) are of unknown cause. In Low-flux modality 3% (n=1) of the patients are having Controlled and 97% (n=30) are having Un-controlled Pre-dialytic BP.. In Low-flux modality 19% (n=6) of the patients are having Controlled and 81% (n=25) are having Un-controlled Intra-dialytic BP. While comparing Intra Dialytic Weight Gain (IDWG), the p-value obtained is greater than 0.05. Hence, it has been concluded that there does not exist any statistically significant difference in IDWG across Low-flux and High-flux modalities of hemodialysis. While comparing the number of requiring antihypertensives in Low and High flux modality, the obtained p value is > 0.05. Hence it has been concluded that there is no statistically significant difference in antihypertensive requirement across Low or High flux modality. While comparing effect of smoking over Uncontrolled Pre-dialytic BP, in each of Low and High flux modality the obtained p value is > 0.05. Hence it has been concluded that smoking is not associated with Uncontrolled Pre-dialytic BP in either Low or High flux modality. While comparing effect of smoking over Uncontrolled Post-dialytic BP, in each of Low and High flux modality the obtained p value is > 0.05. Hence it has been concluded that smoking is not associated with Uncontrolled Post-dialytic BP in either Low or High flux modality. In Low-flux modality out of 31 patients 42% (n=13) are having normal hemoglobin level and 58% (n=18) are anemic. In High-flux modality out of 31 patients 39% (n=12) are having normal hemoglobin level and 61% (n=19) are anemic. The study shows that in both Low Flux and High Flux modalities of dialysis, many of the patients are having anemia. Here the p-value obtained is greater than 0.05. Hence, it has been concluded that there is no statistically significant association between Low-flux and High-flux modalities of hemodialysis and hemoglobin profile of patients. The study shows that in respect to requirement of Erythropoietin dose, the p-value obtained is greater than 0.05. Hence, it has been concluded that there does not exist any statistically significant difference in requirement of Erythropoietin across Low- flux and High-flux modalities of hemodialysis.
The study shows that in respect to requirement of Iron dose, the p-value obtained is greater than 0.05. Hence, it has been concluded that there does not exist any statistically significant difference in requirement of Iron across Low-flux and High- flux modalities of hemodialysis.
Conclusions:
Both the Low flux and High flux modalities of hemodialysis are equally efficacious in terms of blood pressure control and there is no difference in requirement of antihypertensives across these two modalities. Both the Low flux and High flux modalities of hemodialysis are equally efficacious in terms of maintaining adequate hemoglobin level and there is no difference in requirement of Iron and Erythropoietin dose across these two modalities.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.