Dialysis Adequacy and Associated Factors for End-Stagerenal Disease at Korle Bu Teaching Hospital, Accra-Ghana in 2018

Abstract

Background: Globally, achieving dialysis adequacy is a major concern for hemodialysis patients and clinicians. Dialysis adequacy measures the dose of dialysis required for a patient to obtain a long-term good prognosis. However, demographic, clinical, biochemical factors, and treatment characteristics affect this goal. Although several studies have been done around the world, no study has been done in Ghana to assess dialysis adequacy and associated factors for end-stage renal disease (ESRD). Objective: This study evaluates dialysis adequacy and associated factors for ESRD at Korle Bu Teaching Hospital. Method: A retrospective cross-sectional study of one hundred and sixty-seven (167) participants receiving hemodialysis at the Korle Bu Teaching Hospital was enrolled in the study. Data was collected, coded, and cleaned with Microsoft Excel 2016, and analyzed using Stata (version 18). Dialysis adequacy was determined using the urea reduction ratio (URR). URR was calculated as pre–urea–post–urea/pre-urea. URR values <0.65 and ≥0.65 were labeled as inadequate dialysis and adequate dialysis, respectively. The independent variables were categorized as socio demographic, clinical, biochemical factors, and treatment characteristics. After the univariate logistic regression, variables found to be statistically significant at 0.05 were subjected to a multivariate logistic regression. Crude and adjusted odds ratios (OR) were reported with their p values and corresponding 95% confidence intervals (CI). Results: Among 167 hemodialysis patients, the prevalence of dialysis adequacy was 31.1% (95% CI: 24.6%–38.5%). Low hemoglobin (anemia) showed the strongest association with reduced adequacy; patients with anemia had 93% lower odds of achieving adequacy in univariate analysis (cOR = 0.07, 95% CI: 0.03–0.19, p<0.001) and 87% lower odds after adjustment (aOR = 0.13, 95% CI: 0.04–0.42, p=0.001). Hypoalbuminemia was also associated with lower adequacy (cOR = 0.43, 95% CI: 0.22–0.85, p=0.016; aOR = 0.37, 95% CI: 0.15–0.87, p=0.023). Conversely, undergoing more than three dialysis sessions per week was linked to higher adequacy (cOR = 7.22, 95% CI: 3.38–15.42, p<0.001; aOR = 2.84, 95% CI: 1.11–7.27, p=0.030). Age, biochemical phosphate and calcium levels, vascular access type, and duration of dialysis were not significantly associated with adequacy. Conclusion: In this study, only one-third (31.1%) of the patient population achieved dialysis adequacy at KBTH. This is a result of suboptimal clinical management, driven by anemia, hypoalbuminemia, and limited session frequency. Addressing these modifiable factors through targeted interventions, coupled with systemic improvements in healthcare service delivery, can enhance outcomes and reduce mortality risks. Collaborative efforts between clinicians, policymakers, and international partners are crucial to overcoming existing systemic barriers.