Achieving the Urea Reduction Ratio (URR) as a Predictor of the Adequacy and the NKF-K/DOQI Target for Calcium, Phosphorus and Ca × P Product in ESRD Patients Who Undergo Haemodialysis
Published: April 1, 2012 | DOI: https://doi.org/10.7860/JCDR/2012/.2009
V. Sunanda, B. Santosh, D. Jusmita, B. Prabhakar Rao
1. Associate Professor in Biochemistry
2. Final year P.G. Student in M.D. Biochemistry
3. Associate Professor in Biochemistry
4. Professor in Biochemistry
NAM E OF DEPARTM ENT (S)/INSTITUTION(S) TO WHICH THE WORK IS ATTRI BUTED :
Prathima Institute Of Medical Sciences, Nagunoor,
Karimnagar, Andhra Pradesh, India.
Correspondence
Sunanda Vusikala
Associate professor,
Department of Biochemistry,
Prathima institute of medical sciences,
Nagunoor, Karimnagar, Andhra Pradesh,India.
Phone: 09703777696
E-mail: dr.sunanda.anil@gmail.com
Introduction: Among patients with end-stage renal disease (ESRD) who are treated with haemodialysis (HD), the solute clearance during dialysis is a determinant of the mortality. Also, elevated serum calcium (Ca), phosphorus (P) or the Ca × P product is associated with cardiovascular calcification and mortality in these patients. Our study was aimed at assessing the targets to be achieved, which were laid down by the NKF-K/DOQI guidelines for the urea reduction ratio (URR), serum calcium (Ca), phosphorus (P) and the Ca × P product in ESRD patients who underwent haemodialysis.
Methods: We retrospectively analyzed the pre-dialysis and post-dialysis blood samples of 35 patients who were on chronic haemodialysis. For the adequacy of the dialysis, the urea reduction ratio (URR) was calculated by (predialysisurea – postdialysisurea) divided by predialysisurea and it was expressed in %. Calcium and phosphorus were measured from the fasting blood samples and the Ca × P product was calculated.
Results: The mean urea reduction rate (URR) was 66.4% (adequate URR is >65%). The Student’s t-test (paired) was done on the results of the pre-dialysis and post-dialysis serum urea, creatinine and the uric acid levels. There was a significant (p<0.001) reduction in these parameters, thus suggesting the adequacy of the dialysis. The levels of the mean serum calcium, phosphorus and the Ca × P product were 8.59 ± 0.78 mg/dL, 5.82 ± 0.98 mg/dL and 49.88 ± 8.42 mg2/dL2 respectively. There was no achievement of the target phosphorus levels but the target levels of calcium and the Ca × P product were achieved.
Conclusion: The NKF-K/DOQI target of the mean urea reduction rate (URR) was achieved, thus suggesting the adequacy of the dialysis. The NKF-K/DOQI target for mean phosphorus was not achieved, thus suggesting the inadequacy of the oral phosphate binders, poor compliance or no proper dietary phosphorus reduction.
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