ABSTRACT
Background: According to KDOQI guidelines, the lower limit of arteriovenous fistula blood flow accounting for 600 ml / min. We have observed that this limit was not enough, at least for our patients. The aim of this work was to prove the hypothesis that this limit must be higher for performing adequate dialysis
Patiemts and methods: Fifty patients on prevalent hemodialysis were included in this study. They were divided into 3 groups; group I: 12 patients formed low flow group, group II: 18 patients formed moderate flow group, and group III: 20 patients formed high flow group. Complete physical examination including clinical fistula examination for patency, were performed for all patients. Laboratory tests performed for all patients included :urea reduction ratio [URR %], serum calcium ,serum phosphorus, calcium - phosphorus product, serum albumin, hemoglobin, serum Iron, serum ferritin, TIBC, Transferrin saturation [TSAT %], Kt / V [number used to quantify hemodialysis treatment adequacy], serum creatinine, together with blood urea before and after session. Fistula blood flow and static venous pressure were determined by Doppler ultrasound. Fistulogram was performed to confirm the fistula stenosis site, whenever detected by Doppler
Results: Mineral bone profile markers, Iron profile markers, together with malnutrition - inflammation complex indicators, were all in favour of moderate and high flow groups, mainly the moderate flow group II due to the presence of much less complications than the other groups
Conclusion: We have to try to perform arteriovenous fistulae for ESRD patients needing regular dialysis, in such a way that fistula blood flow is above 800 ml / min, and it is better to be within the range of 801 - 1600 ml / min
ABSTRACT
30 diabetic female patients were studied for the effect of Ramipril on creatinine clearance and albuminuria, they all were type 2 diabetes mellitus and were on oral hypoglycemic drugs. They all had variable degrees of hypertenison. Ramipril was taken for 3 months in a variable doses between 5 and 10 mg/day. Creatinine clearance and albuminuria were determined before and after treatment. Patients were divided into 3 groups: Group 1: 10 patients with albuminuria and mild hypertension. Group 2: 10 patients with albuminuria and moderate hypertension. Group 3: 10 patients with macroalbuminuria and moderate to severe hypertension. In our study, Group 1 has made maximum benefit of Ramipril as regards highly significant decrease [P= .002] of creatinine clearance and of albuminuria which improved significantly [P=.001]. Group 2 had a lesser success with only decrease of albuminuria significantly [P=.005] but with insignificant decrease of level of creatinine clearance. Group 3 with macroalbuminuria did not benefit from Ramipril effect on albuminuria but there was a significant decrease in creatinine clearance below normal levels [P=.001]. Early and tight control of blood pressure by Ramipril is needed to achieve a success in treating diabetic nephropathy with microalbuminuria. In our study, patients with macroalbuminuria did not benefit from Ramipril treatment