Physical working capacity in hemodialysis patients

Improvments of dialysis and technology and optimal dialysis treatment have a great role in long surviving of hemodialysis patients. However, despite all modern technology, less than 30% of chronic hemodialysed [HD] patients are employed; but little is known about the factors affecting their physical fitness and working capacity. to assess the physical work efficiency in end stage renal disease [ESRD] patients undergoing maintenance HD and possible related factors. Patients and 30 patients with ESRD on maintenance HD for at least one year and 20 normal control subjects were enrolled in the study. To all subjects the followings were done: complete clincal and lab examination with stress on anthropometric measurements [BMI, TSF, MAC, MAMC], serum urea nitrogen, creatinine, total proteins, transferrin, magnesium, HCV antibodies and estimation of work efficiency. Determination of Kt/V and nPCR were also performed for patients only. MAC and MAMC were significantly lower in HD patients than control [P < 0.01] in spite of comparable BMI and TSF denoting that malnutrition affects muscle mass more than fat mass and reflects early protein wasting inspite of normal range of serum total protein. Significant negative correlations were found between duration of HD and both TSF and MAC [Fig. 1]. Hemoglobin and transferrin were significantly lower, while serum magnesium [Mg] was significantly higher in patients [P < 0.01 for all]. Significant positive correlations were detected between serum transferrin and both MAC and MAMc [Fig. 3]. Thus, serum transferrin may be a more reliable estimate of protein manutrition than albumin in HD patients. Vo2 during the last minute of exercise and energy expenditure were significantly increased with dimunution in work efficiency of HD patients than controls [P < 0.001 for all]. Serum Mg was negatively correlated to work efficiency [Fig. 2]. Patients with hemoglobin less than 8 gm/dl, on HD for > 72 months and/or positive for anti HCV antibodies showed a tendency towards lower levels of work efficiency. malnutrition present in most of HD patients wer more marked in muscle than fat mass. Reduced work efficiency in HD patients was multifactorial: anemia, long duration of dialysis treatment, presence of HCV infection and distrubed Mg level seem to be among the important factors

Clinical and laboratory study of ascites in hemodialysis patients

Ten patients with chronic renal failure [CRF] on maintenance hemodialysis [HD] with ascites [group I], 10 patients with CRF on maintenance HD without ascites [group II] and 10 healthy subjects as controls [group III] were studied for the level of immune complex [IC] in the serum and ascitic fluid in order to investigate a possible relation to hemodialysis ascites. All patients in groups I and II [GI, GII] were seronegative for hepatitis BSAg and antibodies for hepatitis C infection. Serum albumin was more than 3 g/dl in all of them and they had normal aspartate and alanine transaminases [AST, ALT] and prothrombin time, except for two patients in GI with mild elevation of AST and ALT. Nonspecific and specific cultures of ascitic fluid in patients of GI were negative for bacteria or mycobacteria and cytological examination of ascitic fluid did not show malignant cells. Circulating immune complexes [CIC] were significantly increased in GI and GII than the control with no significant difference between them. A positive correlation was found between CIC and ascitic fluid IC, on the one h and, and S. creatinine, on the other h and, in patients in GI which suggested that elevated levels of CIC in them could be due to simple retention due to impaired renal function. No correlation was found between the level of CIC and duration of HD or degree of ascites in GI. Also, occurrence of ascites in HD patients was not related to duration of HD or previous peritoneal dialysis

Study of changes in the anion gap before and after recovery from diabetic ketoacidosis

In this work, 23 patients with diabetic ketoacidosis [DKA] were studied. Nine patients had insulin-dependent diabetes mellitus [IDDM], while 14 patients had non-insulin-dependent diabetes mellitus [NIDDM]. Three patients died during the course of the study. From each patient, blood samples were taken both initially and at the time of recovery for analysis of serum sodium, potassium, chloride, glucose, total proteins, urea, creatinine, pH and plasma bicarbonate. The study revealed that DKA presented with a broad spectrum of acid base patterns, ranging from pure high anion gap [HAG] acidosis to pure hyperchloremic acidosis with normal anion gap [NAG]. On recovery from ketotic state, hyperchloremia with NAG was the predominant finding

Role of the lung in patients with chronic renal failure under periodic hemodialysis

Fifteen patients with chronic renal failure were submitted to periodic hemodialysis by travenol hemodialyzer in the renal unit; Faculty of Medicine, Alexandria. Spirometric lung functions, blood gasometry and acid-base balance were evaluated before dialysis, immediately after dialysis and 24 hours later. The results alluded to the possibility of small-air way error in the essentially clear chest roentgenogram of these patients. However the ventilatory compensation of the lungs was still tremendous to keep the homeostatic balance within the acceptable range thriving for optimal performance