RESUMEN
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