Maintenance hemodialysis in end-stage renal disease associated with spinal cord injury.

Abstract

ABSTRACTData on maintenance hemodialysis in end‐stage renal disease (ESRD) associated with spinal cord injury (SCI) are lacking. Forty‐three SCI‐ESRD patients treated with hemodialysis in our unit were retrospectively studied. A control group of ESRD patients without SCI were included for comparison. Predialysis concentrations of Na, K, bicarbonate, creatinine, albumin, calcium, and phosphorus and anion gap were significantly lower in the SCI group than in the control group. In contrast, chloride concentration was significantly higher in the SCI patients. Hemodialysis was equally effective in providing azotemia control and acid‐base, electrolyte, and fluid balance in both groups. Interdialytic weight gain in the SCI group was significantly less than that of the control group. Hypotensive episodes during dialysis were quite common in the SCI patients. Interestingly, hypertensive episodes during or shortly after dialysis were also noted with considerable frequency. The hypotensive episodes usually responded to blood flow reduction and/or fluid administration. Hypertensive episodes were usually mild to moderate and reversed with continued dialysis without requiring vigorous intervention. The leg cramps often seen in ambulatory patients due to rapid ultrafiltration and fluid shifts were uncommon among the SCI patients. However, diffuse painful muscle spasms caused by uninhibited spinal reflexes were observed with considerable frequency and presented a difficult therapeutic problem. Due to prolonged immobilization and other factors, SCI‐ESRD patients appear to be at high risk of thromboembolic disorders. SCI‐ESRD patients thus appear to differ from the ambulatory ESRD patients from both clinical and biochemical viewpoints. These specific feaures can be of significant value with respect to the dietary and therapeutic considerations.