title: Do hemodialysis adequacy data reflect reality?
abstract: Hemodialysis (HD) adequacy requires monitoring in line with standards and at appropriate intervals. However, the use of inappropriate or incorrectly applied techniques in the determination of HD adequacy can lead to highly unfortunate results. This study was intended to identify the path to a solution by determining how far HD adequacy in HD centers in our region reflects reality. Three hundred and thirty HD patients from eight centers were included. On the first visit, predialysis and postdialysis blood collection with the centers' own methods being used were observed and errors were recorded. Kt/V1 was calculated from pre- and postdialysis blood specimens taken by the units themselves. On the second visit, one session later, pre- and postdialysis blood samples were collected in line with guidelines by ourselves, the authors, and Kt/V2 was calculated from these samples. The eight units' total Kt/V2 value was significantly lower compared with Kt/V1 (<0.0001). The level of patients in all centers with Kt/V1 <1.2 was 13.5%, and that of patients with Kt/V2 <1.2 was 22.1%. No center, apart from one unit, managed to complete the collection of blood specimens as recommended by the guidelines. With one exception, blood collection for HD adequacy was not performed using proper technique in any center. This simple but easily overlooked situation, HD being regarded as adequate though in fact it is not, may lead to patients not being treated effectively and accurately and to a rise in mortality and morbidity in the long term.
authors.affiliation: Department of Nephrology, Karadeniz Technical University, School of Medicine, Trabzon, Turkey. sulusoy2002@yahoo.com
authors.forename: Sukru
authors.initials: S
authors.lastname: Ulusoy
authors.forename: Erdal
authors.initials: E
authors.lastname: Güngör
authors.forename: Semih
authors.initials: S
authors.lastname: Gül
authors.forename: Gulsum
authors.initials: G
authors.lastname: Ozkan
authors.forename: S Caner
authors.initials: SC
authors.lastname: Karahan
authors.forename: Dede
authors.initials: D
authors.lastname: Sit
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Akdag
authors.forename: Cevat
authors.initials: C
authors.lastname: Topal
authors.forename: Adnan
authors.initials: A
authors.lastname: Yavuz
authors.forename: Kübra
authors.initials: K
authors.lastname: Kaynar
authors.forename: Omer
authors.initials: O
authors.lastname: Bıçak
authors.forename: Ismail
authors.initials: I
authors.lastname: Bayraktutan
authors.forename: Seyit
authors.initials: S
authors.lastname: Hisoğlu
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D010043:Outcome and Process Assessment, Health Care / Q000592:standards*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011237:Predictive Value of Tests; D019984:Quality Indicators, Health Care / Q000592:standards*; D006435:Renal Dialysis / Q000009:adverse effects / Q000592:standards*; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey; D014508:Urea / Q000097:blood
chemical_list: D015415:Biomarkers; D014508:Urea