International Journal of Clinical Biochemistry and Research

Print ISSN: 2394-6369

Online ISSN: 2394-6377


International Journal of Clinical Biochemistry and Research (IJCBR) open access, peer-reviewed quarterly journal publishing since 2014 and is published under auspices of the  Innovative Education and Scientific Research Foundation (IESRF), aim to uplift researchers, scholars, academicians, and professionals in all academic and scientific disciplines. IESRF is dedicated to the transfer of technology and research by publishing more...

  • Article highlights
  • Article tables
  • Article images

Article statistics

Viewed: 226

PDF Downloaded: 168

Shekhar, Singh, Sinha, and Tripathy: Effect of haemodialysis on renal profile in chronic renal failure patients at a tertiary care centre


Chronic kidney disease (CKD), also called Kidney or renal failure can be a temporary (often acute) condition or become a chronic condition resulting in the inability of the kidneys to filter waste from the blood. CKD is considered as a serious health problem throughout the globe.1 The reported prevalence of CKD in different regions ranges from 1% to 13%, and recently, data from the International Society of Nephrology’s Kidney Disease Data Centre Study reported a prevalence of 17% in India.2

Chronic renal failure induces a slow and progressive decline of kidney function. It is usually a result of complications from another serious medical condition. Unlike acute renal failure, which happens quickly and suddenly, chronic renal failure happens gradually - over a period of weeks, months, or years - as the kidneys slowly stop working, leading to end-stage renal disease (ESRD) and due to steady and continued decrease in renal clearance or glomerular filtration rate (GFR), there is gathering of urea, creatinine and other waste biomolecules in the blood.3 According to the Kidney Disease Improving Global Outcomes (KDIGO) declaration GFR of less than 60 mL/minute/1.73 m2 is the indication of CKD. KDIGO additional classified the CKD in different stages which are: GFR 30 to 60 mL/minute as stage three; GFR 15 to 30 mL/minute as stage four; and GFR less than 15 mL/minute as stage five of CKD. Because of challenges in access to care, over 50% of patients with advanced CKD are first seen when the eGFR is, 15 ml/min per 1.73 m2.4

Haemodialysis is considered as a good therapeutic option in the context of the renal replacement therapies. Body waste product including urea, creatinine and free water are removed from the blood in case of impaired kidneys. From an economic point of view, dialysis is considered cheaper compared with the high cost of renal transplant. So, dialysis has superiority over renal transplant particularly, when the possibility of rejection is taken into account.5 The procedure of haemodialysis is performed two to three times in a week and the time of dialysis is from two to four hours. The time of dialysis depends on various factors, including kidney function, amount of waste in body, level of salts and body weight.5 The various frequent complications of haemodialysis include sleeping sickness, low blood pressure, chest pain, nausea, leg cramp, anaemia and headache.6

In view of above a study has been made to evaluate the pre-dialysis and post-dialysis mean values of serum renal biochemical markers in CRF patients undergoing dialysis to elucidate the effect of dialysis on CRF patients.

Materials and Methods

A hospital based cross-sectional study was conducted in the department of Biochemistry in collaboration with the department of Medicine and dialysis unit Narayan Medical College & Hospital, Sasaram, Bihar. The study was conducted from March 2018 to December 2019 comprising of 84 subjects. The present study was started after obtaining ethical clearance from the institutional ethical committee. Informed consents were obtained from all the participants of the study.


The data was collected from patients of CKD who were on dialysis in the age group of 21 to 70 years. In the patients group, 62 were males and 22 were females. The selection of patients was based on previous diagnosis with chronic kidney disease, according to KDIGO guidelines (CKD is defined as abnormalities of kidney structure or function, present for >3 months, with implications for health," and requires one of two criteria documented or inferred for >3 months: either GFR <60 ml/min/1.73 m2 or markers of kidney damage, including albuminuria.)7

Biochemical examination

Blood samples was collected before and four hours after haemodialysis. About 10 ml of venous blood was collected into plain red top venipuncture tube without additives or anti-coagulants. Haemolysis was avoided. Blood was allowed to clot. Plain tube was centrifuged and serum was separated and stored at 2- 80 C until it was analyzed within next two days. Serum was used for estimating urea, creatinine, uric acid, Ca+2, Na+ and K+. Serum urea , creatinine, uric acid and Ca+2 were analyzed in an automated analyzer (ERBA – EM-200). Serum Urea was estimated by diacetyl monoxime (DAM) method. Serum uric acid was estimated by uricase method. Serum calcium was estimated by Arsenazo method. Serum creatinine was estimated by using Jaffe’s alkaline picrate method. Serum Na+ and K+ were analyzed in ion selective Electrode machine Ecolyte (Eschweiler, Germany).

Statistical analysis

Statistical analysis was performed using SPSS software version 20.0 Data were expressed as mean ± SD for continuous variables. Independent t test and chi square test were done to analyze the data. A p value <0.05 was considered statistically significant.


The present study was conducted with 84 patients of CKD receiving haemodialysis at regular intervals in dialysis unit, NMCH, Sasaram. The study constituted a total of 84 cases, age ranged from 21 to 70 years (mean 38± 10.5 years) diagnosed with CKD. The most frequent causes of CKD among the studied group was hypertension, followed by diabetes mellitus; then glomerular nephritis, and cardiovascular diseases. Serum urea, creatinine, uric acid, Ca+2, Na+ and K+ were estimated before and four hours after haemodialysis and the values are shown below.(Table 2)

Maximum number of cases (n=26; 31%) were in the age group of 41-50 years followed by 51-60 years age group (n=24; 28.5%) and 61-70 years age group (n=18; 21.5%). 10 cases (12%) were observed in 31-40 years of age while 6 cases were younger than 30 years. (Table 1)

Table 1

Frequency of cases in different age groups

Age Interval (in years)


Percentage (%)
















Table 2

Effects of Hemodialysis on the Serum urea, Serum creatinine, Serum uric acid, Serum Na+ and Serum K+ and Serum Ca+ in patients with renal failure before and after Hemodialysis


Before Haemodialysis. (Mean ± SD)

After Haemodialysis (Mean ± SD)


Serum Urea (mg/dl)




Serum Creatinine (mg/dl)




Serum Uric Acid (mg/dl)




Serum Sodium (mEq/L)




Serum Potassium (mEq/L)




Serum Calcium (mg/dl)




In the present study, we found serum urea level (mg/dl) before and after haemodialysis were 164.23±43.72 and 48.54±29.35 respectively. Before haemodialysis, serum creatinine levels (mg/dl) were 8.2±2.7 which deceased to 3.24±1.42 after haemodialysis with a significant p value of < 0.001. In the renal parameter serum uric acid was also estimated and its level (mg/dl) before and after haemodialysis were 5.84±0.94 and 2.83±0.74 respectively. Serum Calcium level (mg/dl) before and after haemodialysis were 8.2±0.23and 8.9±0.93 respectively with a significant p value of < 0.005. All above mentioned biochemical parameters were evaluated by fully automated blood chemistry analyzer ERBA EM- 200.

In the present study we also estimated serum electrolyte sodium and potassium through ion selective electrode. Pre-dialysis and post-dialysis serum sodium level (mEq/L) were 134.78±5.2 and 137.45±3.84 respectively, and the results were statistically significant with p value <0.004. Before haemodialysis, serum Potassium levels (mEq/L) were 5.17±1.2 which decreased to 3.8±1.1 after haemodialysis with a significant p value of < 0.001. (Table 2)


Chronic renal failure (CRF) describes the gradual loss of kidney function with decrease in glomerular filtration rate. Hypertension, diabetes mellitus, Chronic pyelonephritis, autosomal dominant polycystic kidney disease, autoimmune cause, amyloidosis etc forms the most common cause of chronic renal failure.8 It is generally characterized by high amount of creatinine, blood urea nitrogen value and proteinuria which predict an accelerated loss of renal function that irreversibly leads to end stage renal disease.9 10

These biochemical changes of the blood reflect the sign and symptoms of the disease. By measuring the serum level so the compounds excreted by the kidneys, assessment of the renal excretory functions can be done and therefore serum levels of different biomolecules and electrolytes in the body fluids such as that of urea, creatinine, uric acid, sodium, potassium, and calcium etc can also be used as a diagnostic tool in assessment of renal diseases. Hence; we evaluated the pre-dialysis and postdialysis mean values of serum renal biochemical markers in CRF patients undergoing dialysis to elucidate the effect of dialysis on CRF patients.

Dialysis is a process whereby the solute composition of a solution, A, is altered by exposing solution A to a second solution, B, through a semi permeable membrane. During this process, smaller molecules and water molecule moves through semi permeable membrane but heavier molecules cannot. So the concentrations of heavier molecules (like proteins) don’t change on either side of the membrane and it remains unchanged. On this principle, haemodialysis works.11 Haemodialysis removes waste and water from circulating blood outside the body through an external filter, called dialyser, which contains a semi permeable membrane. The blood from a peripheral artery of the patient is allowed to flow on one side of the membrane and the dialysate flows by other side but in opposite direction. The counter current flow of the blood and the dialysate maintains a maximum concentration gradient of solutes between the blood and dialysate that helps to remove more urea and creatinine from blood. The solute concentration in the dialysate is so designed as to maximize diffusion of water and solute across the membrane. The net effect is the reduction of toxic molecules to the low levels in the blood while improving the levels of the essential ones.12

The result of our study showed that significant variation in the levels of the different renal biochemical parameters under study in the cases before dialysis and after dialysis.

Effect on serum urea levels

In the present study, we observed that group showed an increase in the levels of the urea in pre-dialysis stage and there was significant decrease in serum urea concentration after haemodialysis. Our finding is very much consistent with the findings of study of Owb WF Jr et al. on 13,473 patients. They also found that Women had higher urea reduction ratios than men during treatment.13

Effect on serum creatinine levels

Our study revealed that high creatinine level in pre dialyzed patients. In the post dialysis stage, serum creatinine level was reduced to a significant level. The observation of reduced creatinine level in hemodialyzed patient correlates with similar studies done by Asaad DA et al. on 60 patients in baquba teaching hospital and Rakesh et al. in Bihar.14, 15 The observation is suggestive of clearance of Creatinine and urea from blood during hemodialysis.

Effect on serum uric acid levels

Several experimental and epidemiological studies have suggested that uric acid is a causal or independent risk factor in the progression of renal diseases. The rise in serum uric acid in chronic renal failure is substantially mitigated by marked reduction of its biosynthesis via down regulation xanthine oxidase and upregulation of its secretion by colonic epithelium.16, 17 It has been observed in our study that pre-hemodialysis stage uric acid was very much high than normal reference level and there was a significant fall after hemodialysis (P value <0.003). This is in agreement with the findings of study of Ahmed M Met al on 50 patients in Sudan.18

Effect on serum sodium levels

In the present study, serum sodium levels in the pre-dialyzed cases are lower than the normal reference value. The change in serum sodium is due to lowering of renin secretion from the kidney that is important in sodium control, because of failing large part of kidney.19 Our study showed a marginal increase in serum sodium levels after dialysis and is statistically significant (p-value < 0.004). The increased level in serum sodium might be affected by a high-sodium dialysis solution. Study by Mohammad DK et al. also showed similar results in CRF patients undergoing haemodialysis.20

Effect on serum potassium levels

The current study showed that serum potassium level in post – dialyzed patients was significantly low (P<0.001) compared to mean serum level of pre- dialyzed patients. Hyperkalemia reduces the resting membrane potential, slow the conduction velocity and increases the rate of repolarization. Hypokalemia on the other hand increases the resting membrane potential, and refractory period, which are potentially arrhythmogenic.21 This finding of our study is well supported by the findings of study done by Gulavani GA et al. in Pune, Maharashtra.

Effect on serum calcium levels

Our study indicates that serum calcium levels was low in pre dialyzed patients which increased in all subjects post haemodialysis and is statistically significant (p-value < 0.005). Hypocalcemia in CKD is due to hypophosphatemia associated with CKD, decrease in the number of calcium sensing receptor and vitamin D receptor in the parathyroid glands. There is also deficiency of 1, 25 dihydroxycholecalciferol which is the active form of vitamin D that helps in absorption of dietary calcium from the gut.22 In a similar study, Swati Bhagat et al. reported a significant increase in serum calcium level after haemodialysis.23 This finding of our study is also well-supported by findings of study by Correa S et al. in US.24


Our study concluded that chronic renal failure patients have higher serum urea, creatinine, uric acid and potassium level and decreased level of sodium and calcium leading to various other dangerous diseases. Haemodialysis, one form of the renal replacement therapy, led to the significant decrease in serum urea, creatinine, uric acid and potassium level with significant increase in serum calcium and sodium concentration.

Source of Funding


Conflict of Interest

The authors declare that there is no conflict of interest.



B Ene-Iordache N Perico B Bikbov S Carminati A Remuzzi A Perna Chronic kidney disease and cardiovascular risk in six regions of the world (ISN-KDDC): A cross-sectional studyLancet Glob Health2016430719


OB Latiwesh HH Elwerfally DS Sheriff M Younis Hematological changes in predialyzed and hemodialyzed chronic kidney disease patients in LibyaIOSR J Dent Med Sci20171610612


N Amin RT Mahmood MJ Asad M Zafar AM Raja Evaluating urea and creatinine levels in chronic renal failure pre and post dialysis: a prospective studyJ Cardiovasc Dis20142214


S Varughes G Abraham Chronic Kidney Disease in India: A Clarion Call for ChangeClin J Am Soc Nephrol20181358024


N Khasawnah JA Abeeleh Hematological and biochemical findings among Jordanian patient with end stage renal diseaseEur Sci J2015113


M Unruh MK Tamura B Larive A Rastogi S James B Schiller Impact of Sleep Quality on Cardiovascular Outcomes in Hemodialysis Patients: Results from the Frequent Hemodialysis Network StudyAm J Nephrol201133539840610.1159/000326343


AS Levey PE de Jong J Coresh MEl Nahas BC Astor K Matsushita The definition, classification, and prognosis of chronic kidney disease: a KDIGO Controversies Conference reportKidney Int201180172810.1038/ki.2010.483


A Padmanabhan S Gohil NM Gadgil P Sachdeva Chronic renal failure: An autopsy studySaudi J Kidney Dis Transplant2017285455110.4103/1319-2442.206441


A Dorgalaleh M Mahmudi S Tabibian Anemia and thrombocytopenia in acute and chronic renal failureInt J Hematol Oncol Stem Cell Res201374349


E Ritz I Rychlík F Locatelli S Halimi End-stage renal failure in type 2 diabetes: A medical catastrophe of worldwide dimensionsAm J Kidney Dis199934579580810.1016/s0272-6386(99)70035-1


JT Daugirdas PG Blake TS Ing Handbook of dialysis5th EditionLippincott, Williams and WilkinsNew York2008359


S Chakraborty R Kumari N Chhetri A Mukherjee G Bhattacharya I Bhattacharjee Serum electrolytes and alkaline phosphatase levels in post-dialysis subjects: A hospital based study from Eastern IndiaJ Evid Based Med Healthc20163693775810.18410/jebmh/2016/808


WF Owen NL Lew Y Liu EG Lowrie JM Lazarus The urea reduction ratio and serum albumin concentration as predictors of mortality in patients undergoing hemodialysisN Engl J Med1993329141001610.1056/nejm199309303291404


DA Asaad AS Sultan Changes in Freet3; T4 Thyroxine and Thyrotropin in Hemodialysis and Non-Dialysis Chronic Renal Failure PatientsIndian J Public Health Res Dev20191010


R Kumar MP Singh MD Mehdi Hospital Based Study On Thyroid Function In Patients With Chronic Kidney Disease In Kosi Region Of BiharInt J Recent Sci Res2015634125


C Park Y Obi E Streja CM Rhee CJ Catabay ND Vaziri Serum uric acid, protein intake and mortality in hemodialysis patientsNephrol Dialy Transplant2017321010.1093/ndt/gfw419


I Beberashvili I Sinuani A Azar G Shapiro L Feldman K Stav Serum uric acid as a clinically useful nutritional marker and predictor of outcome in maintenance hemodialysis patientsNutrition20153111384710.1016/j.nut.2014.06.012


MM Ahmed OF Idres Effect of Hemodialysis on Serium Uric Acid, Urea, Creatinine and Albumin Level in Chronic Renal Failure Patients201624851


AM Aljebory TJ Al-Salman HW Alasedi AY Beyi Effect of Kidney Dialysis on Some Biochemical VarianceJ Phys201912945052019


DK Mohammad Effect of Hemodialysis and peritoneal dialysis on some hematological and biochemical parameters in renal failureZanco J Med Sci20091327985


WH Ajam Evaluating of Serum Electrolyte Changes in Chronic Renal Failure Pre and Post DialysisMedico-legal Update20202049803


R Phukan R Goswami A study of serum sodium and calcium status in both hemodialysed and conservatively treated chronic kidney disease patients attending a tertiary care hospital of Assam, IndiaInt J Res Med Sci201641254051010.18203/2320-6012.ijrms20164218


S Bhagat B Bhougal V S Chandel R Kumari S Bhagat S K Bali Effect of Dialysis on Upper Gastrointestinal Symptoms and Endoscopic Findings Along with Biochemical Parameters in Patients of Chronic Renal Failure: A Cross-sectional Study in Tertiary Care Settings in North India


S Correa KM Scovner JA Tumlin P Roy-Chaudhury BA Koplan AI Costea Electrolyte Changes in Contemporary Hemodialysis: A Secondary Analysis of the Monitoring in Dialysis (MiD) StudyKidney202110.34067/KID.0007452020


© This is an open access article distributed under the terms of the Creative Commons Attribution License - Attribution 4.0 International (CC BY 4.0). which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Article type

Original Article

Article page


Authors Details

Sudhanshu Shekhar, Ram Ranjan Singh, Rakesh Sinha, Sunita Tripathy

Article History

Received : 21-03-2021

Accepted : 24-03-2021

Available online : 30-04-2021

Article Metrics

View Article As


Downlaod Files