Spirometry parameters in patients undergoing hemodialysis with bicarbonate and acetate dialysates

End-stage renal disease causes impairment of all body organs including the heart and the lung. The main problems in the afflicted patients are pulmonary edema due to increased permeability of the capillaries, intravascular and interstitial volume overload, hypertension, and congestive heart failure. These changes cause altered physiologic and mechanical function of the lungs and subsequently increase in airway resistance. We aimed to study the impact of hemodialysis on spirometry parameters. In a cross-sectional study performed on 41 patients on maintenance hemodialysis, spirometry was done before and after the dialysis session. The patients were on either acetate or bicarbonate hemodialysis with the same method, dialysis machine, and duration of dialysis. Alterations in spirometry parameters including forced expiratory volume in the first second [FEV1], forced vital capacity [FVC], FEV1/FVC ratio, and maximal midexpiratory flow rate were determined and their relation with serum electrolytes, serum creatinine, blood urea nitrogen, and hemoglobin were analyzed. Twenty-nine patients undergoing dialysis with bicarbonate dialysate and 21 on dialysis with acetate were compared. Improvement in spirometry parameters was only significant in patients undergoing dialysis with bicarbonate dialysate. All spirometry parameters showed significant increases in the bicarbonate group except for the FEV1/FVC ratio. Furthermore, significant increase in these parameters was only prominent in the men. Postdialysis weight reduction and laboratory indexes had no significant correlation with improvement of spirometry parameters. Dialysis with bicarbonate dialysate causes significant improvement in spirometry parameters in men on maintenance dialysis. This effect might be independent of the effect of removing the volume overload by dialysis

Extracorporeal shock wave lithotripsy and transureteral lithotripsy in the treatment of impacted lower ureteral calculi

We compared the efficacy of extracorporeal shock wave lithotripsy [SWL] with ureteroscopy followed by transureteral lithotripsy [TUL] for the treatment of impacted distal ureteral calculi. A total of 96 patients with solitary impacted distal ureteral calculi were assigned into 2 groups of treatment with SWL [42 patients] and TUL [54 patients] with a 6.9-F semirigid ureteroscope. Characteristics of the patients and the calculi, treatment parameters, clinical outcomes, and patients' satisfaction were assessed for each group as well as efficiency quotient. Demographic characteristics of the patients in the 2 groups were similar as well as the sizes of the calculi. The stone-free rate, 2 months postoperatively, was 71.4% in the patients of the SWL group and 88.9% in those of the TUL group. The efficiency quotient was 56% and 81% for the SWL and TUL groups, respectively [P =.004]. Retreatment rate was 26.2% [11 patients] and 9.3% [5 patients] for the SWL and TUL groups, respectively [P =.027]. Thirty patients in the SWL group [71.4%] and 52 in the TUL group [96.3%] were satisfied with their treatment [P =.001]. There were no major complications in neither of the groups. Minor complications [pain and hematuria] were more common in the TUL group. Based on the results of this study, TUL seems to be more effective than SWL in the treatment of impacted lower ureteral calculi sized smaller than 12 mm, and patients are more satisfied with this treatment method