Introduction
Patients and methods
Study
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Gender: Both
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Age: Older than 20 years
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Maintained on HD (thrice weekly) for ≥6 months.
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Patients with controlled DM or hypertension (HTN) (Uncontrolled blood pressure > 150/90 in average weekly predialysis reading while the patient is on maximum doses of 3 or more antihypertensive medications with ideal dry body weight. Uncontrolled DM means FPG > 130 and PPG > 150 in average weekly reading using bedside glucose measuring devices).
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Recently dialyzed patients (less than 6 months)
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Patients with cognitive impairment
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Patients with mental retardation
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Patients with COPD
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Patients with severe anaemia
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Patient with uncontrolled DM or HTN
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Patients with other system failure
Study design
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The first group (group A) with kt/v > 1.5 (n = 24).
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The second group (group B) with kt/v range from [1.5–1.2] (n = 54).
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The third group (group c) with kt/v < 1.2 (n = 22).
Anthropometric measurements
Specimen collection
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Complete blood count, Liver function tests, serum calcium, serum phosphorus and iPTH were measured.
Subjective methods
Scoring system
Statistical methods
Analytical statistics
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In the statistical comparison between the different groups the normality of distribution in continuous data was checked by kolmogorov-smirnov test, and Shapiro-Wilk normality test
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The significance of difference in groups (A, B, C) was tested using Kruscalwalis’ H test
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The comparison between the three groups was done using Bonferroni post-hoc test. The level of significance was set at p < 0.05.
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Measurements within the same group C before and after improving, were statistically compared using paired t-test or Wilcoxon signed-ranks test for parametric or non-parametric data, respectively. Results are presented as counts for nominal variables, and as mean ± standard deviation (SD) and median (interquartile range) for continuous variables. The level of significance was set at p < 0.05.
Results
Age (Year, Mean ± SD) | 48.8 ± 5.89 |
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DM (N, %) | 26 (26%) |
HTN (N, %) | 82 (82%) |
Original kidney disease | |
• HTN (N, %) | 58 (58%) |
• DM (N, %) | 22 (22%) |
• Stones, pyelonephritis | 12 (12%) |
• Undetermined | 8 (8%) |
Questionnaire’s items | Mean ± SD | Median (IQR) |
---|---|---|
Symptoms / problems list | 71.29 ± 17.27 | 77.08 (70.83–81.25) |
Effect of kidney disease | 65.13 ± 11.03 | 65.63 (95.37–71.87) |
Burden of kidney disease | 55.75 ± 15.78 | 62.50 (50–68.75) |
Work Status | 30.00 ± 33.33 | 25 (0.00–50.00) |
Cognitive function | 84.27 ± 9.96 | 86.67 (80.00–93.33)) |
Quality of Social interaction | 64.27 ± 14.63 | 66.67 (53.33–73.33) |
Sleep | 64.25 ± 18.34 | 70 (58.13–75) |
Overall health | 65.50 ± 20.76 | 70.00 (70–80) |
Patient satisfaction | 44.33 ± 11.42 | 50.00 (33.33–50) |
Physical function | 45.30 ± 12.39 | 45.00 (35.0–53.75) |
Role limitation due to physical function | 31.25 ± 19.26 | 25.00 (25.0–50) |
Pain | 49.90 ± 20.67 | 55.00 (36.87–67.50) |
General health | 52.40 ± 11.84 | 50.00 (45–60) |
Emotional Well Being | 61.36 ± 14.17 | 68.00 (56.00–72) |
Role limitations due to emotional problems | 52.67 ± 28.10 | 66.67 (33.33–66.66) |
Social function | 54.20 ± 21.84 | 62.5(50.00–75.00) |
Energy | 45.70 ± 13.89 | 50.00 (40.00–55.00)) |
Physical composite | 36.60 ± 5.51 | 36.70 (32.47–40.20) |
Mental composite | 42.11 ± 9.11 | 45.20 (36.11–48.23) |
Group A | Group B | Group C | P value. | Group A vs Group B | Group A vs Group C | Group B vs Group C | ||
---|---|---|---|---|---|---|---|---|
Age (Year) | N | 24 | 54 | 22 | 0.636 | |||
Mean | 50.45 ± 1.77 | 49.89 ± 2.38 | 50.64 ± 3.84 | |||||
Mean Ranks | 53.79 | 47.98 | 53.09 | |||||
Pre-urea (mg/dl) | N | 24 | 54 | 22 | 0.206 | |||
Mean | 120.33 ± 28.80 | 129.93 ± 26.35 | 129.00 ± 35.17 | |||||
Mean Ranks | 41.44 | 53.94 | 51.95 | |||||
Pre session weight (Kg) | N | 24 | 54 | 22 | 0.042 | 0.036 | 0.389 | 1.000 |
Mean | 83.48 ± 10.54 | 76.99 ± 11.10 | 79.09 ± 13.99 | |||||
Mean Ranks | 62.98 | 45.11 | 50.11 | |||||
Interdialytic weight gain (Kg) | N | 24 | 54 | 22 | 0.002 | 1.000 | 0.006 | 0.003 |
Mean | 2.35 ± 1.03 | 2.42 ± 0 .95 | 3.20 ± 0.59 | |||||
Mean Ranks | 43.44 | 45.90 | 69.50 | |||||
Dialysis session time (hrs) | N | 24 | 54 | 22 | < 0.0001 | 0.938 | < 0.0001 | < 0.0001 |
Mean | 4.00 ± 0.00 | 3.89 ± 0.32 | 3.05 ± 0.043 | |||||
Mean Ranks | 63.50 | 58.00 | 17.91 | |||||
Serum calcium (mg/dl) | N | 24 | 54 | 22 | 0.001 | 0.010 | 0.001 | 0.568 |
Mean | 9.84 ± 0.83 | 9.22 ± 0.79 | 8.93 ± 0.88 | |||||
Mean Ranks | 68.50 | 47.59 | 38.00 | |||||
Serum Ph (mg/dl) | N | 24 | 54 | 21 | 0.007 | 1.000 | 0.013 | 0.015 |
Mean | 4.65 ± 0.57 | 4.68 ± 1.08 | 5.38 ± 0.77 | |||||
Mean Ranks | 42.73 | 46.56 | 67.17 | |||||
Serum albumin (g/dl) | N | 24 | 54 | 22 | 0.704 | |||
Mean | 3.35 ± 0.40 | 3.27 ± 0.39 | 3.28 ± 0.46 | |||||
Mean Ranks | 54.79 | 49.00 | 49.50 | |||||
Serum PTH (pg/ml) | N | 24 | 53 | 22 | < 0.0001 | 0.480 | < 0.0001 | < 0.0001 |
Mean | 158.10 ± 150.73 | 318.89 ± 486.23 | 750.00 ± 523.20 | |||||
Mean Ranks | 35.25 | 45.18 | 77.70 | |||||
Hb (g/dl) | N | 24 | 54 | 22 | < 0.0001 | 0.012 | < 0.0001 | 0.059 |
Mean | 10.20 ± 1.05 | 9.71 ± 0.86 | 9.10 ± 0.78 | |||||
Mean Ranks | 69.81 | 49.34 | 32.27 | |||||
Kt/v | N | 24 | 54 | 22 | < 0.0001 | < 0.0001 | < 0.0001 | < 0.0001 |
Mean Ranks | 88.50 | 49.50 | 11.50 |
Questionnaire’s items | Kt/V Groups | N | Mean Rank | P value* | P value** | |
---|---|---|---|---|---|---|
Symptoms / problems list | Group-A | 24 | 77.08 | < 0.0001 | Group-A vs Group-B | 0.004 |
Group-B | 54 | 54.57 | Group-A vs Group-C | < 0.0001 | ||
Group-C | 22 | 11.5 | Group-B vs Group-C | < 0.0001 | ||
Effect of kidney disease | Group-A | 24 | 81.9 | < 0.0001 | Group-A vs Group-B | < 0.0001 |
Group-B | 54 | 52.31 | Group-A vs Group-C | < 0.0001 | ||
Group-C | 22 | 11.8 | Group-B vs Group-C | < 0.0001 | ||
Burden of kidney disease | Group-A | 24 | 71.94 | < 0.0001 | Group-A vs Group-B | 0.095 |
Group-B | 54 | 56.86 | Group-A vs Group-C | < 0.0001 | ||
Group-C | 22 | 11.5 | Group-B vs Group-C | < 0.0001 | ||
Work Status | Group-A | 24 | 44.25 | 0.003 | Group-A vs Group-B | 1.000 |
Group-B | 54 | 46.61 | Group-A vs Group-C | 0.086 | ||
Group-C | 22 | 66.86 | Group-B vs Group-C | 1.000 | ||
Cognitive Function | Group-A | 24 | 70.19 | < 0.0001 | Group-A vs Group-B | 0.122 |
Group-B | 54 | 56.06 | Group-A vs Group-C | < 0.0001 | ||
Group-C | 22 | 15.39 | Group-B vs Group-C | < 0.0001 | ||
Quality of Social interaction | Group-A | 24 | 40.27 | < 0.0001 | Group-A vs Group-B | < 0.0001 |
Group-B | 54 | 69.23 | Group-A vs Group-C | 0.011 | ||
Group-C | 22 | 15.68 | Group-B vs Group-C | < 0.0001 | ||
Sleep | Group-A | 24 | 79.35 | < 0.0001 | Group-A vs Group-B | 0.001 |
Group-B | 54 | 53.56 | Group-A vs Group-C | < 0.0001 | ||
Group-C | 22 | 11.5 | Group-B vs Group-C | < 0.0001 | ||
Overall Health | Group-A | 24 | 69.88 | < 0.0001 | Group-A vs Group-B | 0.222 |
Group-B | 54 | 57.78 | Group-A vs Group-C | < 0.0001 | ||
Group-C | 22 | 11.5 | Group-B vs Group-C | < 0.0001 | ||
1.1.Patient Satisfaction | Group-A | 24 | 58.88 | 0.001 | Group-A vs Group-B | 0.021 |
Group-B | 54 | 41.43 | Group-A vs Group-C | 1.000 | ||
Group-C | 22 | 63.64 | Group-B vs Group-C | 0.003 | ||
Physical Function | Group-A | 24 | 66.23 | < 0.0001 | Group-A vs Group-B | 0.071 |
Group-B | 54 | 57.45 | Group-A vs Group-C | < 0.0001 | ||
Group-C | 22 | 16.27 | Group-B vs Group-C | < 0.0001 | ||
Role limitation due to Physical function | Group-A | 24 | 56.96 | 0.39 | Group-A vs Group-B | |
Group-B | 54 | 50.55 | Group-A vs Group-C | |||
Group-C | 22 | 43.34 | Group-B vs Group-C | |||
General Health | Group-A | 24 | 75.79 | < 0.0001 | Group-A vs Group-B | < 0.0001 |
Group-B | 54 | 37.89 | Group-A vs Group-C | 0.001 | ||
Group-C | 22 | 53.86 | Group-B vs Group-C | 0.018 | ||
Pain | Group-A | 24 | 74.75 | < 0.0001 | Group-A vs Group-B | 0.011 |
Group-B | 54 | 55.45 | Group-A vs Group-C | < 0.0001 | ||
Group-C | 22 | 11.6 | Group-B vs Group-C | < 0.0001 | ||
Emotional Well Being | Group-A | 24 | 70.92 | 0.001 | Group-A vs Group-B | 0.171 |
Group-B | 54 | 57.31 | Group-A vs Group-C | < 0.0001 | ||
Group-C | 22 | 11.5 | Group-B vs Group-C | < 0.0001 | ||
1.1.Role limitations due to emotional function | Group-A | 24 | 64.88 | 0.26 | Group-A vs Group-B | |
Group-B | 54 | 53.96 | Group-A vs Group-C | |||
Group-C | 22 | 26.32 | Group-B vs Group-C | |||
Social Functions | Group-A | 24 | 80.35 | < 0.0001 | Group-A vs Group-B | < 0.0001 |
Group-B | 54 | 52.58 | Group-A vs Group-C | < 0.0001 | ||
Group-C | 22 | 12.82 | Group-B vs Group-C | < 0.0001 | ||
Energy | Group-A | 24 | 74.5 | < 0.0001 | Group-A vs Group-B | 0.042 |
Group-B | 54 | 55.72 | Group-A vs Group-C | < 0.0001 | ||
Group-C | 22 | 11.5 | Group-B vs Group-C | < 0.0001 | ||
Physical Composite | Group-A | 24 | 65.92 | 0.002 | Group-A vs Group-B | 0.042 |
Group-B | 54 | 51.33 | Group-A vs Group-C | 0.001 | ||
Group-C | 22 | 31.64 | Group-B vs Group-C | 0.129 | ||
Mental Composite | Group-A | 24 | 70.54 | < 0.0001 | Group-A vs Group-B | 0.149 |
Group-B | 54 | 57.31 | Group-A vs Group-C | < 0.0001 | ||
Group-C | 22 | 11.91 | Group-B vs Group-C | < 0.0001 |
N | Mean ± SD | Median (IQR) | *p value | ||
---|---|---|---|---|---|
Pre-session weight (kg) | Before | 22 | 79.09 ± 13.99 | 79.00 (66.75–87.25) | 0.031 |
After | 78.77 ± 14.02 | 79.00 (66.50–87.25) | |||
Post-session weight (kg) | Before | 22 | 75.82 ± 13.91 | 76.00 (64.00–85.00)) | 0.104 |
After | 75.91 ± 13.99 | 76.00 (64.00–85.37) | |||
Interdialytic weight gain (Kg) | Before | 22 | 3.21 ± 0.59 | 3.00 (3.00–4.00) | 0.025 |
After | 2.86 ± 0.58 | 3.00 (2.5–3.00) |
N | Median (IQR) | *P value | ||
---|---|---|---|---|
Before | After | |||
Dialysis session duration (hrs) | 22 | 3.00 (3–3) | 4.00 | < 0.001 |
PTH (pg/dl) # | 22 | 784.50 (343.50–979.50) | 632.00(343.50–873.75) | 0.002 |
N | Mean ± SD | Median (IQR) | p value* | ||
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Pre-session Urea (mg/dl) | Before | 22 | 129.0 ± 35.17 | 128.50 (98.75–156.00) | 0.668 |
After | 132.00 ± 20.43 | 133.00 (121.25–147.00) | |||
Post-session Urea (mg/dl) | Before | 22 | 56.36 ± 17.32 | 59.50 (40.00–68.50) | 0.001 |
After | 43.73 ± 6.73 | 46.50 (39.75–48.25) | |||
Serum calcium (mg/dl) | Before | 22 | 8.93 ± 0.88 | 9.00 (8.33–9.45) | 0.322 |
After | 8.75 ± 0.79 | 8.9 (8.03–9.43) | |||
Serum phosphorus (mg/dl) | Before | 22 | 5.37 ± 0.75 | 5.40 (4.88–6.03) | < 0001 |
After | 22 | 4.06 ± 0.59 | 4.00 (3.75–4.50) | ||
Serum albumin (g/dl) | Before | 22 | 3.28 ± 0.46 | 3.20 (2.98–3.50) | 0.329 |
After | 3.23 ± 0.49 | 3.15 (2.88–3.43) | |||
Hemoglobin (g/dl) | Before | 22 | 9.17 ± 0.78 | 9.10 (8.50–9.73) | < 0001 |
After | 10.90 ± 0.88 | 10.00 (9.50–10.80) | |||
Kt/v | Before | 22 | 0.99 ± 0.12 | 1.03 (0.96–1.08) | < 0001 |
After | 1.31 ± 0.06 | 1.32 (1.25–1.35) |
Subscales of the questionnaire | N | Median(IQR) | P value* | |
---|---|---|---|---|
Before | After | |||
Symptoms / problems list | 22 | 39.58 (35.42–45.33) | 71.88 (41.67–79.17) | < 0.001 |
Effect of kidney disease | 22 | 50.00 (46.09–53.13) | 59.38 (50.00–68.75) | 0.003 |
Burden of kidney disease | 22 | 31.25 (25.00–31.25) | 50.00 (31.25–62.50) | 0.001 |
Work status | 22 | 50.00 (50.00–50.00) | 50.00 (0.00–50.00) | 0.248 |
Cognitive function | 22 | 73.33 (66.67–73.33) | 80.00 (71.67–86.67) | 0.003 |
Quality of social interaction | 22 | 46.67 (38.33–53.33) | 66.67 (40.00–73.33) | 0.002 |
Sleep | 22 | 35.00 (27.50–40.63) | 62.50 (38.13–70.00) | 0.001 |
Overall health | 22 | 30.00 (20–30) | 70.00 (30.00–70.00) | 0.001 |
Patient satisfaction | 22 | 50.00 (45.83–54.17) | 41.66 (33.33–50.00) | 0.115 |
Physical function | 22 | 32.50 (25.00–35.00) | 45.00 (33.75–55.00) | 0.002 |
Role limitation due to physical function | 22 | 10.00 (0.00–50.00) | 25.00 (25.00–50.00) | 0.415 |
General health | 22 | 55.00 (45.00–11.25) | 47.50 (40.00–55.00) | 0.060 |
Pain | 22 | 12.50 (10.00–22.50) | 45.00(20.00–55.63) | 0.001 |
Emotion well-Being | 22 | 38.00 (32.00–44.00) | 60.00 (40.00–68.00) | 0.001 |
Role limitations due to emotional problems | 22 | 33.33 (0.00–33.33) | 33.33 (25.00–66.67) | 0.194 |
Social function | 22 | 25.00 (12.50–37.50) | 50.00 (25.00–62.5.00) | 0.002 |
Energy | 22 | 25.00 (20.00–26.50) | 45.00 (23.75–55.00) | 0.001 |
Physical composite | 22 | 32.49 (29.30–36.90) | 36.55 (33.99–41.22) | 0.042 |
Mental composite | 22 | 28.05 (24.66–32.21) | 35.40 (27.49–46.86) | 0.002 |
Work status | Physical composite | Mental composite | |
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Kt/v r | −0.168 | 0.304 | 0.587 |
p | 0.068 | 0.002 | < 0.0001 |