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

• Main Authors: V. Sunanda, B. Santosh, D. Jusmita, B. Prabhakar Rao
• Format: Article
• Language: English
• Published: JCDR Research and Publications Private Limited 2012-04-01
• Series: Journal of Clinical and Diagnostic Research
• Subjects: calcium × phosphate (ca × p) product; end stage renal disease (esrd); haemodialysis (hd); hyperphosphataemia; national kidney foundation – kidney disease outcome quality initiative (nkf-k/doqi); phosphate binders; urea reduction ratio (urr)
• Online Access: https://jcdr.net/articles/PDF/2009/5-%204057.A.pdf

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.