Nasal manifestations in patients with chronic renal failure on hemodialysis

Abstract

Background Patients with end-stagerenal disease (ESRD) on regular hemodialysis (HD) show various otolaryngological manifestations owing to uremic toxins and electrolyte imbalance. Previous studies have reported epistaxis as the most common ENT manifestations of ESRD on HD as explained by bleeding tendency related to uremia or HD itself. Nasal crustation, septal perforation, and olfactory dysfunction were also observed in HD patients. Objective To evaluate the frequency of different nasal manifestations among nondiabetic prevalent HD patients. Patients and methods A cross-sectional study was conducted in Ain Shams University Hospital from March 2019 till September 2019. It included 68 eligible nondiabetic patients with ESRD on regular HD more than 6 m. All patients were subjected to full history and clinical examination. CT nose and sinus was done only if indicated. Complete blood count and routine chemistry (blood urea nitrogen, serum creatinine, urea reduction ratio, calcium, phosphorus, parathyroid hormone, and iron profile) were done. Results Most patients did not give a past history of epistaxis (94.1%). Overall, 44.1% of the patients experienced dry nasal mucosa and pale inferior turbinates, and 10.3% of the patients had congested nasal mucosa. Crustations were founded in 7.4% of the patients, although they were found in nearly double percentage in nasal septum (14.7%). The nasal septum deviation and ulceration were found in 2.9% each. Only one (1.5%) patient had nasal septum perforation. The mean level of hemoglobin (g/dl) concentration was 10.4 (range, 6.8–15 g/dl). Conclusion Modern adequate HD techniques have reduced epistaxis in patients with ESRD. The most common ENT manifestations were dry nasal mucosa and pale inferior nasal turbinate and to a lesser extent crustations on both nasal septum and inferior nasal turbinate.