Original Research International Journal of Clinical Biochemistry and Research 2015;2(3):172-176 172 Biochemical Analysis of End Stage Renal Disease Patients Following Regular Haemodialysis Ipsita Dash 1,* , Suchitra Kumari 2 1 Tutor, 2 Assistant Professor, Dept. of Biochemistry, All India Institute of Medical Sciences, Bhubaneswar, Odisha *Corresponding Author: Email: ipsitadash71@gmail.com ABSTRACT Dialysis is in empirical therapy of end-stage renal disease. Traditionally dialysis adequacy has been quantified referring to the Kinetics of urea but recent index of dialysis dose is the fractional clearance of urea expressed as Kt/v. Eighty end stage renal disease cases were enrolled in the study out of which 40 cases underwent two haemodialysis per week (Group A) and rest 40 cases three haemodialysis/week. Serum urea, Creatinine, Potassium registered a significant fall (P<0.001) along with improvement in systolic blood pressure and Haemoglobin concentration (P<0.05) in Group- B whereas Group A cases showed significant fall (P<0.001) in serum urea values only. Urea reduction ratio and Kt/v were found higher in Group B as compared to Group A (P<0.001) which was as per the recommendation of National Kidney Foundation Dialysis outcomes Quality Initiation (K/DOQI). ESRD cases undergoing HD twice a week is inadequate whereas three HD/week cases had better compliance and post dialysis clinical outcome. Keywords: Dialysis, End-stage renal disease, Dialysis dose, Kt/v, Urea Reduction Ratio (URR) INTRODUCTION National kidney foundation Kidney disease outcome quality initiative (NKF-K/DOQI) classified chronic kidney disease (CKD) in to five different stages. The fifth stage is called ESRD where Glomerular filtration rate is less than 15ml per min per 1.73m 2 surface area 1 . End stage renal disease (ESRD) lead to temporary or permanent damage to the kidneys. When 90% or more of kidney function is lost, either kidney transplantation or dialysis is required to sustain life. An Indian population based study determined the crude and age – adjusted ESRD incidence rates at 151 & 232 per million population respectively 2 . It is estimated that about 55 thousands patients are on dialysis in India and the dialysis population is growing at a rate of 10 to 20% annually 3 . Nearly 400,000 persons in United States and 2 million worldwide are dependent on dialysis, of these approximately 90% in United States undergo Haemodialysis which is typically delivered three times a week 4 . Haemodialysis (HD) is preferred over peritoneal dialysis (PD) in ESRD and from the beginning of the dialysis era the issue of optimal dialysis dose and frequency has been the central topic in the delivery of dialysis treatment. Dialysis dosing has been informed by numerous observational studies 5,6 and a few carefully conducted randomized clinical trials 7,8 . Based on literature reports, the American guidelines were issued first (DOQI 1997:K-DOQI,2001) followed by European Based Practice Guideline (2002). The K- DOQI Guidelines recommend a minimum single pool Kt/v(urea) of 1.2 roughly corresponding to a minimum prescribed Urea Reduction Ratio (URR) of 65% for thrice weekly HD 9 . The European Based Practice Guidelines recommend higher values: double-pool Kt/ v (urea) of at least 1.2, single – pool Kt/v (urea) of at least 1.4 10 . Urea Reduction Ratio (URR) is defined as reduction in urea as a result of dialysis. The URR is one measure of how effectively a dialysis treatment removed the waste products from the body and is commonly expressed as a percent. According to National Kidney and Urologic Diseases Information Clearing house (NKUDIC) minimum values of URR should be 65% 1,11 . Other method that was used to measure the accuracy of dialysis dose is Kt/v. The minimum Kt/v should be 1.2 12 . K is defined as total dialyzer residual while t is the period of dialysis in minute. Meanwhile v is defined as urea’s volume of HD patients. Two randomized controlled trials on dialysis adequacy were conducted one performed on HD i.e.; HEMO study and other on peritoneal dialysis (PD) i.e. the ADEMEX study. HEMO study conducted on 1846 patients completed on 2002, documented that the risk of death was the same in high and standard dose group. There was no increase in the health or survival rate of patients who had a higher dialysis dose 7 . However the solute removal can be dramatically augmented by increasing the frequency of haemodialysis sessions 13 . Several uncontrolled studies showed that there were significant improvement in patient - reported outcome and results of laboratory tests when patients were treated with more frequent haemodialysis 14 . The best available evidences at present indicate an uncertainty regarding the optimal dose of Haemodialysis. So the present studies are designed to compare the effectiveness of three HD per week with two HD per week in ESRD patients by evaluating the biochemical parameters. Patient’s acceptance and