A comparison of adequacy and complications of hemodialysis: A quasiexperimental study

Abstract

Background: Hemodialysis, as one of the most commonly used chronic renal failure treatments, increases the level of blood toxins, complications of illness, hospitalized days, imposed costs, and mortality if it does not have the required quality. One of the factors that can be effective in increasing dialysis adequacy in case of patient tolerance and lack of complications is an increasing blood flow, the stepwise profile of dialysis fluid flow. The present study intends to compare these methods in terms of efficiency in increasing the dialysis adequacy against their complications. Materials and methods: In this semi-experimental single-group study, before and after-intervention trials, 22 patients with hemodialysis under the coverage of Special Patients Center in Zabol, who had the criteria to be included in the study were selected by random sampling method and underwent dialysis for 4 sessions using routine methods, increasing blood flow, stepwise profile of dialysis fluid flow, while maintaining all parameters (such as the type of fluid, type and concentration of dialysis fluid, shifts, etc.). At the beginning and the end of the each dialysis session in two methods, the BUN sample was taken before and after dialysis to study the adequacy of dialysis. During the 12 sessions of dialysis, patients were examined before dialysis in terms of lack of hypertension and some symptoms including nausea, vomiting, muscle cramps and other symptoms and then they were monitored directly every 30 min for hypertension, nausea, vomiting, muscle cramps, headaches, and so on. Results: The mean score of adequacy of dialysis was 0.834 ± 0.22 in the routine session, 1.19 ± 0.45 in the method of increasing blood flow and 1.07 ± 0.35 in the stepwise profile of dialysis fluid flow, and there was a significant difference between the mean score of dialysis adequacy in routine session and each method of increasing blood flow and stepwise profiles of dialysis fluid flow using paired t-test (p=0.001). The results from Cochran statistical test showed that there is a significant difference between the routine methods, an increase in blood flow, stepwise profile of dialysis fluid flow profile in terms of the frequency of muscle cramp during hemodialysis (p<0.05) and this difference was statistically significant between the routine session and an increase in blood flow based on McNemar test (p=0.021). Based on the McNamar statistical test, the difference in headache frequency during hemodialysis was significant between the routine session and the stepwise profile of fluid flow (p=0.039). Conclusion: Although the increase in blood flow and dialysis fluid flow in the stepwise method leads to an increase in the adequacy of dialysis, but they are not safe due to their complications and side effects.