Introduction: The precise assessment of hemodialysis adequacy is crucial for determining the clinical prognosis of individuals undergoing chronic hemodialysis. This study investigates the relationship between online clearance monitoring (OCM) and routine monitoring of Kt/V, utilizing the Daugirdas Formula as a benchmark. Methods: The research, conducted on 190 patients with end-stage renal illness undergoing hemodialysis, employed observational methods and excluded critically ill patients and those with non-adherence to prescribed dialysis regimens. The study aimed to assess hemodialysis adequacy by comparing Kt/V values calculated using the Daugirdas formula, OCM, and the urea reduction ratio. Hemodialysis procedures, conducted using Fresenius 4008S equipment, included two blood samplings per patient at the beginning and end of each session. Samples were analyzed for serum Urea, Creatinine, Bicarbonate, Sodium, and Potassium levels. Results: Statistical analysis revealed a lack of significant difference between Kt/V values obtained from the Daugirdas formula and OCM. Results from 190 patients, with an average age of 50.08±12.33 years, demonstrated that the Daugirdas formula and OCM did not significantly differ (P Value=0.175, r 0.169). Conclusion: The study acknowledges limitations such as its single-centre design, limited sample size, and the exclusive representation of Asian ethnicity among participants, the findings offer valuable insights into hemodialysis adequacy assessment. These insights contribute to the ongoing dialogue in the field and provide guidance for clinicians in optimizing dialysis protocols to enhance patient outcomes. The study underscores the need for future research with more diverse cohorts to further validate and extend the applicability of the observed relationships.