Severe post-dialysis hypokalaemia leading to quadriparesis.

A 36-year-old male developed acute renal failure and severe metabolic acidosis following acute severe gastroenteritis. Two hours following haemodialysis he developed generalized muscle weakness, which progressed to quadriplegia over the next 4 hours. Electrocardiography (ECG) revealed classic signs of hypokalaemia. Serum potassium (K+) levels were 0.98 mmol/L. He was immediately started on intravenous (i/v) and oral potassium supplementation. He gradually improved and his ECG changes also reverted as potassium levels normalized. Postdialysis hypokalaemia can be a serious complication in patients who are already in total body potassium deficit. Dialysis fluid potassium levels should be kept higher in such patients.

Assessment of lipid dysfunction in patients on maintenance haemodialysis.

BACKGROUND: Dyslipidaemia is a major risk factor of cardiovascular disease in patients on maintenance haemodialysis. Both increased and decreased levels of cholesterol are associated with increased cardiovascular mortality in haemodialysis patients. OBJECTIVE: To assess the lipid dysfunction among patients on maintenance haemodialysis in a nephrology unit at Rawalpindi as compared with healthy individuals. METHODS: A descriptive comparative study was carried out in a nephrology unit at Rawalpindi, Pakistan. A total of 140 subjects were included consisting of 70 patients on maintenance haemodialysis (MHD) and 70 healthy controls. Body mass index (BMI) was measured according to WHO guidelines. Serum total cholesterol (TC), triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C) were assayed on chemistry analyser. Low-density lipoprotein cholesterol (LDL-C) was calculated by Friedwald equation. RESULT: MHD patients had significantly lower BMI, mean (SD) 20.07 (3.66) as compared with the controls 22.88 (3.97) kg/m2 (p < 0.001). The lipid profile among MHD patients and controls are given as mean (SD): (a) Total Cholesterol 3.84 (1.06) vs 4.65 (0.97) (p < 0.001), (b) LDL-C 2.21(0.77) vs 2.93 (0.71) (p < 0.001), (c) HDL-C 0.95 (0.166) vs 0.97 (0.138) (p = NS), (d) Non HDL 2.88 (0.95) vs 3.67 (0.88) (p < 0.0001), (e) Triglycerides 1.68 (1.09) vs 1.69 (0.86) (p = NS). The most common abnormality observed in haemodialysis patients was low HDL-C (81%) followed by increased Non-HDL-C (23%) and increased serum triglycerides (19%). CONCLUSION: It is concluded that our patients on maintenance haemodialysis have significantly low BMI, total Cholesterol, LDL-C and Non-HDL-C depicting malnutrition leading to inflammation, accelerated atherosclerosis process and cardiovascular complications.

Comparison of calcium acetate with calcium carbonate as phosphate binder in patients on maintenance haemodialysis.

BACKGROUND: Hyperphosphatemia is common in end-stage renal disease patients. Objective of this study is to compare the hypercalcaemic effect and phosphate binding power of calcium acetate and calcium carbonate in end-stage renal disease patients on maintenance haemodialysis. METHODS: This randomised control trial was conducted in four phases with calcium acetate or calcium carbonate. Sixty-four patients on haemodialysis were randomly divided into 2 groups. After a washout period of 2 weeks, each group was given calcium acetate or calcium carbonate for 2 months. After another washout period the patients were crossed over and again received these drugs for 2 months. Serum Calcium, phosphate, and albumin were analysed on Selectra E auto analyser at completion of each phase of study. Hypercalcaemic effect was defined as serum calcium > 2.54 mmol/l, and phosphate binding power as serum phosphate < 1.61 mmol/l. RESULTS: Forty-one patients completed the study. Though lower dose of calcium acetate was used, it resulted in equally good control of hyperphosphatemia as compared with calcium carbonate therapy [1.37 mmol/l (SD 0.33) vs. 1.46 mmol/l (SD 0.34), p = 0.16]. Incidence of hypercalcaemia was higher with calcium carbonate therapy (2.73 +/- 0.67 mmol/l vs. 2.32 +/- 0.28 mmol/l, p < 0.01). Both drugs were well tolerated, but patients more frequently complained of muscle cramps while taking calcium acetate. CONCLUSIONS: It is concluded that calcium acetate has similar effect on serum phosphate levels as compared to calcium carbonate in patients on maintenance haemodialysis. However, calcium acetate results in lesser frequency of hypercalcaemia as compared to calcium carbonate. Tolerance to both drugs was similar, though patients complained of more muscle cramps while taking calcium acetate.