الفهرس 
What is the dialysisadequacy?Only 14 pages are availabe for public view
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Abstract
Dialysis delivery should be adequate to not only improve quality of life and also to prolong survival. The aims of dialysis are thus, to decrease morbidity, improve quality of life and prolong life span. To achieve these aims, dialysis must be performed effectively, effective (HD) is one of important factors that plays a role in decreasing morbidity and mortality of patients, and ineffective dialysis is one of factors causing high mortality of these patients. There are many surveys that indicate the relationship between dose of dialysis and mortality of patients; they concluded that inadequate dose of dialysis increase duration of hospitalization and overall cost of care and complications.
Hemodialysis can only be adequate when all symptoms and signs of uremia are eradicated, the patient is fully rehabilitated and the kidney failure does not interrupt activities of daily living.
from clinical perspective, probably the best marker of adequacy is a physically active, well nourished, non-anemic, normotensive with no complaint .
Two methods generally used to assess dialysis adequacy are URR and Kt/V . The Kt/V is more accurate than the URR in measuring how much urea is removed during dialysis, primarily because the Kt/V also considers the amount of urea removed with excess fluid.
The URR is very useful method for measuring dialysis adequacy because of its simplicity. It permits easy monitoring of the amount of dialysis therapy delivered to individual patients, as well as across dialysis units, groups of units, states, regions, or countries, because monthly predialysis and postdialysis urea nitrogen values are routinely measured. It also permits quality control and improvement initiatives and regulatory oversight.
The last two decades have witnessed a better understanding of uremic toxicity, salt and water control, correction of anemia and metabolic abnormalities including calcium-phosphate metabolism and dyslipidemia in chronic kidney disease dialysis patients (CKD-5D)
Kt/V is used to measure how effective a dialysis treatment is in removing wastes. National guidelines recommend a Kt/V of at least 1.2 for each dialysis treatment.
Numerous studies have confirmed the relation between dialysis dose and hemoglubin level and hemoglobin (Hb) fluctuation was closely related to the prognosis of the maintenance hemodialysis patients. This relation as regarding to many factors as time, frequency, modality of dialysis.is
Hypertension is very common in patients undergoing regular conventional hemodialysis treatment. Increasing delivered dialysis dose showed that both systolic and diastolic BP decrease statistically significantly. It was recognized that hypertension in HD patient could be difficult to control, but that normal BP values could be achieved by adequate dialysis and ultafiltration in 80-90% of patients.
In dialysis patients, hypoalbuminemia is a strong predictor of poor outcomes.
Creation and maintenance of a functional AVF will remain one of the greatest challenges in the dialysis field.the AVF is considered to be the access of choice
Phosphate levels are an independent predictor of survival in dialysis patients and factors determining phosphate levels include: level of residual kidney function, dietary intake of phosphate , degree of secondary hyperparathyroidism, use of vitamin D metabolites, dialysis adequacy and time on dialysis per se , dose of phosphate binders and compliance with their use.
Studies identified serum phosphate level as a prognostic factor in patients on hemodialysis .
Independent of phosphorus and PTH levels, increased calcium levels have also been associated with greater all-cause and cardiovascular mortality risk, and poor mental health
In this study we found the following:
• Urea levels decreased significantly after dialysis.
• URR and Kt/V had consistent results.
• Precisely, 57.4% of patients achieved URR targets by dialysis.
• A total of 60.3% of patients achieved Kt/V targets by dialysis.
• A total of 72.1% of patients achieved albumin targets by dialysis.
• A total of 63.2% of patients achieved calcium levels by dialysis.
• A total of 52.9% of patients achieved phosphorus targets by dialysis.
• A total of 52.9% of patients achieved haemoglobin targets by dialysis.
• Patients with lower URR and Kt/V were less likely to achieve calcium, phosphorus, albumin or haemoglobin targets by dialysis.
• Blood pressure of patients decreased significantly by dialysis.
• A-V fistula was the most common vascular accessamong the patients of our study .It was noticed that dialysis adequacy statistically lowered among the patients whom had a vascular access other than AV-fistula.