Outcome of end-stage renal disease patients with advanced uremia and acidemia

Objective: To determine the outcome of End-Stage Renal Disease [ESRD] patients presenting with advanced uremia and acidemia requiring hemodialysis and adverse events seen within 72 hours of admission

Study Design: Cross-sectional study

Place and Duration of Study: Sindh Institute of Urology and Transplantation, Karachi, Pakistan, from October 2010 to March 2011

Methodology: ESRD patients with advanced uremia and acidemia were included in the study. History, physical examination, complete blood count, serum urea, creatinine, electrolytes, arterial blood gases analysis, and ultrasound of kidneys were done in each patient. Adverse events and outcome were recorded for the next 72 hours. Data was analyzed by SPSS version [10]. Mean value and standard deviation of quantitative measurements were calculated and statistical significance computed by t-test. A p-value

Results: Out of the 194 ESRD patients [mean age 46.54 +/- 14.07 years], 28 [14%] expired and 166 [86%] survived within 72 hours of admission. Hypotension requiring inotropic support was the commonest adverse event observed in 40 [20.6%] cases followed by fits in 31 [16%]; and 25 [12.9%] patients required ventilatory support. Mortality was high in patients above 50 years of age. There was no statistically significant difference between two genders regarding adverse events and mortality

Conclusion: The morbidity and mortality of patients with ESRD are serious concerns. Early referral of patients with ESRD, before they develop severe acidosis, can prevent significant morbidity and mortality

Pulmonary hypertension and leading factors in patients undergoing dialysis

To determine the frequency and leading factors of pulmonary hypertension among chronic hemodialysis patients. Case series. Hemodialysis Unit, Department of Nephrology, Sindh Institute of Urology and Transplantation, Karachi, from September 2011 to March 2012. Patients of either gender aged between 16 to 60 years of age undergoing hemodialysis for at least 3 months not having pre-existing valvular heart disease, chronic lung disease or connective tissue disorder were included. Pulmonary hypertension was prospectively estimated by Doppler echocardiogram on patients undergoing dialysis. Pulmonary artery pressure was calculated on the post-dialysis day and leading factors were compared between patients with and without pulmonary hypertension. A total of 178 patients were included in study with male to female ratio120/58 [2.06:1]. The mean age was 33.84 +/- 11.9 years. The mean duration of hemodialysis was 23.85 +/- 22.48 months. Pulmonary hypertension was found in 76 [42.7%] patients. Out of the studied factors, low serum albumin [< 3.4 mg/dl, p = 0.01] was found to be statistically significant in patients with pulmonary hypertension. Pulmonary hypertension was frequently present in dialysis population [42.7%]. This subset of patients had significantly lower albumin levels in serum. More research is needed in its pathogenesis to arrest its course