Study design and setting
This cohort cross-sectional study was carried out at Mogadishu Somali-Turkey Training and Research Hospital in Mogadishu, the capital of Somalia, which is the largest teaching and referral hospital in the country.
All adult patients who received their first hemodialysis session during this study protocol between October 2018 and July 2019. Total of 151 patients who fulfilled the eligibility criteria have been included in the study.
Patients with malignancy, on routine hemodialysis, with a history of recent trauma, surgery or burns, with the evidence of acute infection, with a history of chronic liver disease and history of aspirin use, were excluded from the study.
The ethical approval was obtained from Instituitional Review Board (IRB) of Mogadishu Somali Turkey, Recep Tayyip Erdogan, Training and Research hospital and informed consent was taken from the patients.
Demographics like age and gender were obtained from medical records. Routine biochemical tests were performed with an autoanalyzer (Mindray BS-400 Clinical Chemistry Analyzer). Parameters such as white blood cell (WBC) count, MPV, platelet count and hemoglobin (Hb) were obtained from blood samples with an autoanalyzer (Sysmex XN-1000 Sysmex Corporation, Kobe, Japan).
Prior to hemodialysis, blood samples were obtained for measurement. Again, prior to the first HD session, MPV-level and platelet count among other laboratory values were measured for each patient, with these repeated following the fourth HD session. The interval between the time blood samples were drawn and their subsequent analysis was less than 30 minutes.
All patients underwent native hemodialysis with a temporary jugular catheter using the Fresenius 4008S dialysis machine. The first HD session was 2 hours and the folowing HD sessions were 4 hours duration each. Each hemodialysis session utilized a dialyzer with a blood flow rate of 250 to 300 ml/min, where the dialysate flow was 500 ml/min.
We used SPSS 25.0 (IBM Corporation, Armonk, New York, United States) and PAST 3 (Hammer, Ø., Harper, D.A.T., Ryan, P.D. 2001. Paleontological Statistics) programs with regard to variable analysis. The Shapiro-Wilk Francia test evaluated the conformity of the univariate data to normal distribution. In contrast, the Mardia (Doornik and Hansen omnibus) test evaluated the conformity of multivariate variables to normal distribution. Comparison of the two independent groups according to the quantitative data was conducted via the Independent Sample t-test in conjunction with the Bootstrap results. The Bootstrap results were also employed with the Paired-Sample t-test.
The Wilcoxon signed-rank test, however, was used with the Monte Carlo simulation with respect to the comparison of the two quantitative dependent variables' repetitive measurements. The analysis of the correlation between the variables after controlling for the effects of age and gender was undertaken via the Partial Correlation test, with the analysis of the correlation between the variables before controlling for the effects of age and gender conducted via Kendall's Tau-b test.The quantitative data were set out in the tables as Mean ± SD (standard deviation) (Minimum/Maximum) and Median (1st quartile/3rd quartile), while the categorical variables were n (%). Analysis of the variables was conducted at the 95% confidence level and a p-value of less than 0.05 was held to be significant.