Introduction:
In olden days, kidney failure was considered equivalent to death. With the creation of Scribner shunt in 1960, patients with end-stage kidney disease got new ease of life, and hemodialysis (HD) became an established therapy for ESKD. HD perform functions of the kidney, like removal of water, electrolyte balance, bone health, and blood pressure control. The question now is how much dialysis patients need in terms of duration and frequency and how to best measure its adequacy. While Kt/V is a common marker for dialysis adequacy, it alone may not fully capture effectiveness. We need additional factors beyond small solute clearance to evaluate adequate dialysis. This study aims to correlate Kt/V and Comprehensive Dialysis Index (CDI), consisting of 10 parameters, with patient-reported outcome measures (PROMs).
Methods:
We conducted a single-center, observational, prospective study on patients completing 3 months on maintenance HD. CDI, comprising 10 parameters (each scored 0 or 1 as per recommended target), includes hemoglobin, predialysis sodium, potassium, bicarbonate, calcium, phosphorus, albumin, weekly Kt/V, IDWG, and predialysis BP. PROMs assessed using Karnofsky Performance Scale (score10–100, with higher being better) and 36-item Kidney Disease Quality of Life (KDQOL) questionnaire (5 domains, scored in percentage), administered during dialysis sessions. Nutritional status assessed with Subjective Global Assessment (SGA). SPSS (version 23) was used for data analysis; chi-square test for associations, and Pearson’s correlation coefficient for relationships between variables, with a significance level of <0.05. Kaplan-Meier estimate used for calculating survival index.
Results:
Among 99 patients, 58 were male and 41 female. Fifty-two percent were aged 50 to 70 years, with a mean of 57.7 years. Dialysis vintage ranged from 4 months to 11 years (mean 3 years 2 months). Seventy percent of patients achieved a weekly Kt/V >2.1. Twenty-six percent had a CDI >8, and sixty percent had CDI between 5 and 7. CDI correlated significantly with the Karnofsky Physical Performance Score (p < 0.01) and SGA (p = 0.0067), whereas Kt/V did not. No significant correlation was found between KDQOL and either CDI or Kt/V. There was no significant gender difference in KDQOL scores. Patients with high-flux dialyzers reported better outcomes in KDQOL concerning kidney disease effects. AV fistula users reported better symptom management compared to catheter users (p = 0.017). Secured funding improved mental health scores, though not significantly. Survival probability at 18 months was 0.86. CDI showed a weak (0.18) but positive correlation with mortality, suggesting higher CDI scores associated with longer survival time, while for Kt/V, this correlation was very weak (0.05).
Conclusions:
The study found that Kt/V alone does not strongly correlate with patient-reported outcomes. In contrast, CDI showed significant correlations with the Karnofsky Physical Performance Score and SGA, also showing better correlation with survival. This suggests that a comprehensive approach, incorporating multiple parameters like CDI, may better reflect patients' health and well-being than relying solely on Kt/V. Our study highlights the need for holistic assessments to better understand the effectiveness and impact of dialysis on patients' lives.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.