| dc.description.abstract | Introduction: Kidney failure in Uganda is among the top 10 causes of death. Hemodialysis (HD) substitutes the natural work of the kidney thereby prolonging patients’ survival while improving their quality of life. An optimal HD dose as measured by spKt/V or urea reduction ratio (URR) is a crucial determinant of clinical outcomes for chronic hemodialysis patients. Despite the importance of optimal hemodialysis adequacy (HDA), no prior studies have been conducted in Uganda. Study objective: This study aimed to determine the prevalence, explore healthcare workers' perspectives, and identify factors associated with optimal hemodialysis adequacy among adult patients with kidney failure at Kiruddu National Referral Hospital. Methods: This was a sequential explanatory mixed methods study on adult patients with kidney failure on hemodialysis and purposively selected healthcare workers actively providing hemodialysis care at the facility. Data on socio-demographic characteristics, clinical, and dialysis-related factors were extracted from 122 patient records dialyzed at KNRH in September 2022 whereas healthcare workers’ perspectives on factors that influence optimal HDA were explored through in-depth interviews until data saturation was reached. URR and spKt/V were calculated to determine optimal HDA. The data were analyzed and associated factors for optimal HDA were determined using modified poisson regression with robust standard errors. The perspectives of healthcare workers on factors that influence optimal HDA at KNRH were analyzed through inductive content analysis. Results: A total of 122 patient records were extracted and 08 healthcare workers were interviewed. Males represented 69.7% of the study population. The median age was 43 years (IQR 34-54). Only 48.4% (95% CI: 42.7-60.5) based on URR and 30.3% (95% CI: 22.7-39.2) based on spKt/V received optimal HDA. Multivariable analysis showed that males were less likely to achieve optimal HDA (aPR 0.55, 95% CI 0.38-0.79, p=0.001). Patients who used a dialysate flow rate ≥500mls/min (aPR 0.68, 95% CI 0.59-0.99, p=0.030) and those with dialysis vintage ≥ 12 months (aPR 0.67, 95% CI 0.46-0.98, p=0.040) were also less likely to achieve optimal HDA by URR criteria. Conversely, malnourished patients (aPR 1.46, 95% CI 1.02-2.09, p=0.040) and those who used a blood flow rate ≥250mls/min (aPR 1.47, 95% CI 1.03-2.10, p=0.012) were more likely to achieve optimal HDA by URR criteria. Qualitatively the biological factors that were found to influence HDA at KNRH were; sex, vascular access type, comorbidities, blood composition, malnutrition, electrolyte imbalances, and intradialytic weight gain. The healthcare system factors were; financial constraints, poor adherence to healthcare policies, dialysis frequency, staffing levels, dialysis machine quality and maintenance, facility infrastructure, and dialysis prescriptions. Conclusion: The study revealed a low proportion of patients with optimal HDA, with less than half of the patients meeting the international standard. Male gender, higher dialysate flow rates, and longer dialysis vintage were negatively associated with optimal HDA, while malnutrition and higher blood flow rates were positively associated with optimal HDA. | en_US |
