Abstract

Background: The adequacy of hemodialysis is a vital indicator of treatment quality and patient survival among individuals with end-stage renal disease. In Iraq, regional disparities and inconsistent monitoring have limited the understanding of dialysis performance and its determinants. Aim of the Study: To assess the adequacy of hemodialysis across Iraq from 2011 to 2025, focusing on regional variations, contributing factors, and related clinical outcomes. Method: A systematic review and meta-summary were conducted according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eight eligible studies from Baghdad, Erbil, Karbala, Najaf, Diyala, Sulaimani, Basra, and national multicenter data were analyzed. Owing to differences in study design and reporting, data were synthesized narratively. Hemodialysis adequacy was defined as a single-pool Kt/V of at least 1.2 or a urea reduction ratio of 65 percent or higher. Results: Adequacy rates ranged from 28.6 to 73 percent, with dialysis centers in Erbil achieving higher levels than those in other cities. Determinants of adequacy included longer session duration, higher blood flow rate, and the use of arteriovenous fistulas. Adequate dialysis was associated with higher hemoglobin levels, better biochemical and nutritional parameters, fewer hospitalizations, and improved quality of life. The mean adequacy of hemodialysis, excluding Erbil city hemodialysis centers, was 41.7%. Conclusion: Hemodialysis adequacy in Iraq remains below international standards. Strengthening infrastructure, standardizing national protocols, and establishing a national dialysis registry are essential to improve dialysis quality and patient outcomes.