• Dana Ahmad Sharif Department of Medicine, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.
  • Nahida Mohammad Marif Shar Hospital, Ministry of Health, Sulaimani, Kurdistan Region, Iraq.



Chronic kidney disease, Hemodialysis, Adequacy of dialysis



Hemodialysis is one form of renal replacement therapy in patients with end-stage renal failure. The adequacy of dialysis is an essential factor in reducing the various complications experienced by these patients.


To evaluate hemodialysis adequacy in seven dialysis centres of Sulaimani governorate investigate whether changing the dialysis shift to the morning session with nutritional support can improve the dialysis adequacy or not.

Patients and Methods

A prospective case-control interventional study on 135 patients on Hemodialysis during their regular schedules in seven centres in Sulaimani governorate from November 2018 to May 2019. 

We divided into groups A and B. Group A consisted of 109 patients named the control group. Group B consisted of 26 patients called the intervention group, where we changed their time of the dialysis session from the evening to the morning shift along with particular diet advice.


The age of the patients ranged from 12 to 71 years. Sixty-one participants were males, and 74 were females. The mean clearance of urea per time over the volume of distribution KT/V in group A was 1.20 compared to 1.54 in group B. Similarly, in group A, the mean urea reduction ratio URR was 59.96, compared to 71.21 in group B. These were all statistically significant. 


Dialysis adequacy is sufficient in all dialysis centres in Sulaimani centres. The study showed that shifting the dialysis session to the morning with diet advice may further improve dialysis adequacy.


- Levey, A.S., Coresh, J., Bolton, K., Culleton, B., Harvey, K.S.,et al… 2002. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. American Journal of Kidney Diseases, 39(2 SUPPL. 1).

-Hakim RM, Breyer J, Ismail N, Schulman G. Effects of dose of dialysis on morbidity and mortality. Am J Kidney Dis (2011) 1994; 23:661-9. DOI:

- Schiffl, H., Lang, S.M. and Fischer, R., 2002. Daily hemodialysis and the outcome of acute renal failure. New England Journal of Medicine, 346(5), pp.305-310 DOI:

- Chertow GM, Johansen KL, Lew N, Lazarus JM, Lowrie EG. Vintage, nutritional status and survi-val in hemodialysis patients. Kidney Int. 2000; 57 (3):1176-81. DOI:

- Port FK, Eknoyan G. The Dialysis Outcomes and Practice Patterns Study (DOPPS) and the Kidney Disease Outcomes Quality Initiative (K/DOQI): A cooperative initiative to improve outcomes for hemodialysis patients worldwide. American journal of kidney diseases. 2004 Nov pp.1-6 DOI:

- Kaysen GA, Don BR. Factors that affect albumin concentration in dialysis patients and their relationship to vascular disease. Kidney International. 2003 May pp. 4-7. DOI:

-Tonelli M, Wiebe N, Culleton B, House A, Rabbat C, Fok M, McAlister F, Garg AX. Chronic kidney disease and mortality risk: a systematic review. Journal of the American Society of Nephrology. 2006 Jul pp .34-47. DOI:

-Depner TA. Prescribing hemodialysis: a guide to urea modeling. Springer Science & Business Media; 2012 Dec 6.

- Suri R, Depner TA, Blake PG, Heidenheim AP, Lindsay RM. Adequacy of quotidian hemodialysis. American journal of kidney diseases. 2003 Jul pp.42-48 DOI:

- Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000; 894:i-xii, 1-253.

- Combe C, Chauveau P, Cano N, Canaud B, Roth H, Leverve X, etal, French Study Group Nutrition in Dialysis. Influence of nutritional factors and hemodialysis adequacy on the survival of 1,610 French patients. American journal of kidney diseases. 2001 Jan 1; 37(1):S81-8. DOI:

- Shinaberger CS, Kilpatrick RD, Regidor DL, et al ,Longitudinal associations between dietary protein intake and survival in hemodialysis patients. American journal of kidney diseas es. 2006 Jul 1; 48(1):37-49. DOI:

-Noori N, Kalantar-Zadeh K, Kopple JD et al, Dietary potassium intake and mortality in long-term hemodialysis patients. American journal of kidney diseases. 2010 Aug 1; 56(2):338-47. DOI:

- St-Jules DE, Woolf K, Pompeii ML, Sevick MA. Exploring problems in following the hemodialysis diet and their relation to energy and nutrient intakes: the BalanceWise Study. Journal of Renal Nutrition. 2016 Mar 1;26(2):118-24. DOI:

- Nesrallah GE, Lindsay RM, , Zimmerman D, Lockridge RS et al . Intensive hemodialysis associates with improved survival compared with conventional hemodialysis. Journal of the American Society of Nephrology. 2012 Apr 1;23(4):696-705. DOI:

- Isakova T, Gutierrez OM, Chang Y et al . Phosphorus binders and survival on hemodialysis. Journal of the American Society of Nephrology. 2009 Feb 1;20(2):388-96. DOI:

- Birdee GS, Phillips RS, Brown RS. Use of complementary and alternative medicine among patients with end-stage renal disease. Evidence-Based Complementary and Alternative Medicine. 2013 Jan 1;2013. DOI:

- Lindley EJ. Beyond the current paradigm: Recent advances in the understanding of sodium handling–Guest Editors: Stanley Shaldon and Joerg Vienken: Reducing sodium intake in hemodialysis patients. InSeminars in Dialysis 2009 May (Vol. 22, No. 3, pp. 260-263). Oxford, UK: Blackwell Publishing Ltd. DOI:

- Wong F, Jalan R, Ronco al . Working Party proposal for a revised classification system of renal dysfunction in patients with cirrhosis. Gut. 2011 May 1;60(5):702-9. DOI:

- Sharif DA, Awn AH, Murad KM, Meran IM. Demographic and characteristic distribution of end-stage renal failure in Sulaimani Governate, Kurdistan Region, Iraq. Int J Med Res Prof. 2017;3:155-8.

-Imai E, Horio M, Watanabe Tet al. Prevalence of chronic kidney disease in the Japanese general population. Clinical and experimental nephrology. 2009 Dec;13(6):621-30. DOI:

- Afshar R, Sanavi S, Salimi J. Epidemiology of chronic renal failure in Iran: a four year single center experience. Saudi Journal of Kidney Diseases and Transplantation. 2007 Apr 1;18(2):191.

- Saeed HS, Sinjari HY. Assessment of hemodialysis efficacy in patients with end-stage renal failure in the Erbil hemodialysis center. Medical Journal of Babylon. 2018 Oct 1;15(4):276. DOI:

- Borzou, S.R., Torkaman, B et al. The effect of increasing blood flow rate on dialysis adequacy in hemodialysis patients. Saudi Journal of Kidney Diseases and Transplantation, 2009 , 20(4), p.639.



How to Cite

Sharif D, Marif N. ADEQUACY OF HEMODIALYSIS IN PATIENTS WITH END-STAGE RENAL FAILURE IN SULAIMANI GOVERNORATE. JSMC [Internet]. 2021 Sep. 21 [cited 2024 May 28];11(3):351-8. Available from:

Similar Articles

1-10 of 156

You may also start an advanced similarity search for this article.

Most read articles by the same author(s)