Ultrasonographic measurement of inferior vena cava diameter as an index of ultrafiltration adequacy in dialysed uraemic patients

This study was designed to assess the adequacy of ultrafiltration during dialysis by ultrasonographic measurement of inferior vena cava [IVC] diameter in both normotensive and hypertensive dialysed uraemic patients and to determine whether control of extracellular fluid volume by ultrafiltration is correlated with blood pressure control. Fifty patients were studied; 25 normotensives [group I] and 25 hypertensives [group II]. The patients of the later group were followed for 8 month with gradual increase in ultrafiltration and decrease in the dose and the number of anti-hypertensive agents. In addition to thorough clinical examination including blood pressure body weight sampling for estimation of blood urea pre and post dialysis and calculation of Kt/V which is defined as the rate of urea removal normalized for body surface, serum creatinine, haemoglobin concentration and ultrasonographic measurement of IVC diameter predialysis and 2- hours post dialysis were done. Results showed that body weight and IVC diameter were significantly [p<0.001] higher in group II compared with group I and were significantly lower at post dialysis time compared to predialysis time in both groups while haemoglobin levels and Kt/V showed insignificant changes. At the endof the follow up period for group II patients: 10 patients [group IIa] normotensives with ultrafiltration only without antihypertensive drugs, 9 patients [group IIb] became normotensives with ultrafiltration plus antihypertensive drugs and 6 patients [group IIc] remained hypertensives despite ultrafiltration and hypertensive drugs. A significant negative correlations was observed between the duration of dialysis in years and both the systolic and diastolic blood pressures, body weight and Kt/V and IVC diameter and Kt/V. In conclusion ultrasonographic measurement of IVC diameter assessment of adequacy of ultrafiltration to control hypertension in dialysis patients. Thus avoiding the side effects of antihypertensive drugs and decrease the cost. Routine sonographic assessment of IVC diameter in dialysis patients is recommended

Modified low density lipoprotein and lipoprotein [A] as atherogenic risk factors in haemodialysis patients

Biochemical characteristics of low-density lipoprotein [LDL] particles as well as serum lipids and lipoprotein [a] concentrations were determined in 32 uremic patients on maintenance HD and 20 healthy control. The study revealed that LDL from uremic patients contained significantly increased amount of fructosyl lysine as an index for the degree of glycosylation and thiobarbituric acid reactive substances as an index for the degree of oxidation and significantly decreased amounts of sialic acid and vitamin E compared with the controls. Furthermore, lipid composition of LDL changed where triglycerides increased significantly, while cholesterol decreased significantly in patients compared with controls. All together, serum triglycerides [TG], total cholesterol [TC]/HDL cholesterol ratio and serum lipoprotein [a] [Lp [a]] were increased significantly, HDL-cholesterol was decreased significantly; while TC and LDL- cholesterol showed insignificant changes in patients compared with the controls. Lp [a] and TC/HDL ratio were significantly negatively correlated with serum albumin levels and Lp [a] was significantly negatively correlated with creatinine clearance