Dialysis Adequacy - a Difficult Challenge

Mostafi, Mamun; Jabin, Masrura

doi:10.3329/jbcps.v37i4.43343

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“…Dialysis adequacy is important in reducing complications for patients and is influenced by various factors including co-morbidities of patients, economy, distance to DF, supervision of nephrologists. A study in Dhaka, Bangladesh found that patients receiving 12 hours per week of hemodialysis had better adequacy (43%) compared to those receiving only 8 hours (21%) [ 31 ]. According to the KDOQI Guidelines of 2006, incremental HD is suggested to maintain residual renal function at estimated glomerular filtration rate (eGFR) less or equal 15 ml/min/1.73m 2 [ 32 ], while in Bangladesh, most HD patients starts at eGFR of 6–7 ml/min/1.73m 2 .…”

Section: Discussionmentioning

confidence: 99%

Dialysis capacity and nutrition care across Bangladesh: A situational assessment

Ripon,

Ahmed,

Rahman

et al. 2023

PLoS ONE

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Hemodialysis (HD) is a treatment for ensuring the survival of end-stage kidney disease (ESKD) patients, and nutrition care is integral to their management. We sent questionnaires to evaluate the total dialysis service capacity and nutrition services across all dialysis facilities (DF) in Bangladesh, with responses from 149 out of 166 active DFs. Survey results revealed that 49.7% of DFs operated two shifts, and 42.3% operated three shifts daily, with 74.5% holding between one and ten dialysis machines. Sixty-three percent of DFs served between one and 25 patients per week, and 77% of patients received twice-weekly dialysis. The average cost for first-time dialysis was 2800 BDT per session (range: 2500–3000 BDT), but it was lower if reused dialyzers were used (2100 BDT, range: 1700–2800 BDT). Nutritionists were available in only 21% of the DFs. Parameters related to nutritional health screening (serum albumin, BMI, MIS-malnutrition inflammation assessment, and dietary intakes) were carried out in 37.6%, 23.5%, 2%, and 2% of the DFs, respectively, only if recommended by physicians. Nutrition education, if recommended, was provided in 68.5% of DFs, but only in 17.6% of them were these delivered by nutritionists. The recommendation for using renal-specific oral nutrition supplements (ONS) is not a familiar practice in Bangladeshi DFs and, therefore, was scarcely recommended. Dialysis capacity across Bangladesh is inadequate to meet current or projected needs and nutrition education and support across the DFs to benefit improving patients’ quality of life is also inadequate.

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Section: Discussionmentioning

confidence: 99%