Dialysis Recovery Time and Its Associated Factors in Patients Undergoing Haemodialysis at the Kenyatta National Hospital

Abstract

Background: Patients with ESRD on maintenance haemodialysis are known to have reduced Health Related Quality of Life (HRQoL). One of the major factors postulated to contribute to this phenomenon is prolonged Dialysis Recovery Time (DRT), also known as Time to Recovery (TTR) after a single HD session. DRT is defined as the perceived time after completion of HD after which a patient can resume his/her daily activities. DRT is a quantifiable and validated measure of post-dialysis fatigue and serves as a useful indicator of dialysis adequacy. DRT has been shown to be an effective indicator the assessment of risk for hospitalization and mortality. Objectives : The aim of this was study was to evaluate the Dialysis Recovery Time (DRT) of patients undergoing maintenance HD at the Kenyatta National hospital and to evaluate the factors that influence DRT. Methods: This was a cross-sectional study carried out at Kenyatta National Hospital (KNH) Renal Unit over a period of 3 weeks. The study population was ambulant patients on maintenance HD for a period of 3 or more months. All those who met the inclusion criteria were enrolled into the study. After attaining an informed consent, the PI and Research assistants screened the dialysis charts for completeness and collected data of interest. Patients meeting the eligibility criteria were asked the internationally validated question “how long does it take you to return to your normal activities after a dialysis session?”. The responses were recorded and categorized into <2 hours, 2 to 6 hours, >6 to 12 and >12 hours. The patients then filled out the Human Activity Profile questionnaire independently or with assistance from a guardian or relative. Exploratory data analysis was done to identify and describe the patterns in the data. Statistically associations between DRT and patient clinical and demographic characteristics were analyzed using Chi- Square and student T-test. Analysis of Variance (ANOVA) was used to analyze the association between DRT and Maximum Activity Score (MAS) / Adjusted Activity Score (AAS). Results: A total of 96 patients participated in this study, 51(53.1%) of whom were male and 45(46.9%) female. The mean age was 43.0(± 1.4). 24%, 40%, 26% and 9% of patients reported DRTs of <2 hours, 2 to 6 hours, >6 to 12 hours and > 12 hours respectively. Longer DRTs were associated with IDWG (p= 0.030, 95% CI= 0.39 - 0.95) and UFR (p= 0.026, 95% CI= 0.80 - 0.99). Male patients were at least 3 times as likely to recover faster than females (OR = 3.25, 95%CI= 1.15 - 9.19). No statistical association was found with Age, dialysis vintage, marital status, education level, Pre-/ and Post-HD BP, BMI, dialysis access or blood flow rate. The mean Maximum Activity Score (MAS) and mean Adjusted Activity Score (AAS) was 63.9 (±14.9) and 56.7 (±18.5) respectively, both of which were found to have a statistically significant association with DRT; MAS (p=<0.001) and AAS (p=<0.001). Conclusion: This study finds that patients at the KNH renal unit have significantly prolonged DRT with lack of physical exercise, poor physical functioning and sub-optimal fluid control (as depicted by uncontrolled pre-dialysis BPs and IDWG) being the main factors responsible.