Abnormalities In Hemodialysis Patients Research Articles

Inefficient Dialysis and Hematological Abnormalities in End-Stage Renal Disease Patients: A Cross-Sectional Study

Purpose: End-stage renal disease (ESKD) necessitates hemodialysis, a life-sustaining therapy that mimics kidney function. This study aimed to investigate the association between markers of inadequate dialysis efficacy and the prevalence of hematological abnormalities in patients undergoing hemodialysis. Methods: A cross-sectional study was conducted among 61 patients receiving hemodialysis at Mesallata Central Hospital, Libya, in October 2024. Data were collected on hematological parameters (white blood cell count, hemoglobin, mean corpuscular volume, and platelet count) and laboratory markers of dialysis adequacy, including blood urea nitrogen (BUN), serum creatinine, and Kt/V values. Statistical analyses assessed correlations between dialysis adequacy markers and hematological abnormalities. Results: The findings revealed significant associations between elevated BUN and serum creatinine levels, lower Kt/V values, and the presence of anemia and thrombocytopenia. Suboptimal dialysis adequacy (Kt/V < 1.2) was observed in 67.2% of patients. Anemia was prevalent, with 75.4% of patients exhibiting low hemoglobin levels and 77% and 86.9% showing reduced mean corpuscular volume and hemoglobin levels, respectively. Elevated white blood cell counts were present in 23% of patients. Significant correlations were found between Kt/V values and serum creatinine (r = -0.68, p < 0.01) as well as hemoglobin levels (r = 0.45, p < 0.01). Conclusion: These results suggest a potential link between inadequate dialysis efficacy and hematological abnormalities in hemodialysis patients. Optimizing dialysis protocols and continuous monitoring are essential to improve patient outcomes and address these complications.

Association between Visit-to-Visit Ultrafiltration Volume Variability, Vascular Biomarkers and Cardiovascular Parameters in Chronic Hemodialysis Patients

Background. Cardiovascular (CV) diseases are the most common causes of morbidity and mortality in hemodialysis (HD) patients. We studied the effect of high visit-to-visit ultrafiltration (UF) variability on CV abnormalities in HD patients. Methods. Twenty-nine consecutive patients (age: 65.6 ± 10.4 years) were recruited. Samples for routine lab tests were drawn pre-HD for syndecan-1 (SDC-1) and endothelin-1 (ET-1) measurements pre-, mid- and post-HD. Applanation tonometry was performed pre-, mid- and post-HD. Visit-to-visit ultrafiltration volume variability (UVSD) was calculated as the standard deviation of the UF volume/dialysis session in the preceding 12 months. Echocardiography was performed post-HD. Results. Patients were divided into two groups based on the median of UVSD (500 mL). The average UF volume/HD was not different between the groups. Blood pressure (BP) values were similar. Pre-HD cfPWV (10.75 m/s) was lower in the high UVSD group (14.1 m/s, p = 0.03). In the high UVSD group, post-HD cfPWV (13.9 m/s) was higher than the pre-HD cfPWV (p < 0.05). Pre-HD ET-1 was lower in the high UVSD group (8.6 ± 3.9 vs. 10.8 ± 2.7 pg/mL, p < 0.05). Left ventricular end-diastolic diameter (LVEDD) and left ventricular mass index (LVMI) were higher in the high UVSD group (55.7 ± 7.3 vs. 51.0 ± 5.4 mm and 449.9 ± 180.5 vs. 350.3 ± 85.9 g/m², p < 0.005, respectively). Left ventricular ejection fraction (LVEF) was lower in the high UVSD group (53.5 vs. 60, p < 0.05). Conclusions. High UVSD was associated with increased left ventricular hypertrophy and dysfunction and decreased LVEF compared to low visit-to-visit UV variability despite similar UF volumes temporarily compensated by more elastic arteries. The observed abnormalities may increase CV risk.

Evaluation of abnormal Chest X-rays for hemodialysis patients

Background: A chest x-ray is the most practical way to evaluate lung disease. There are different degrees of pulmonary abnormalities in hemodialysis patients. The diagnosis of pulmonary disease in hemodialysis patients can be challenging due to the complex findings and multiple manifestations. Objective: This study aimed to identify and evaluate the accuracy and consistency of chest radiographs in the diagnosis of pulmonary abnormalities in hemodialysis patients, Also highlight the limitations of CXR for diagnoses. Materials and methods: We collected and reviewed chest radiographs of 60 hemodialysis patients with various pulmonary manifestations. Two experienced radiologists independently interpreted CXR uptake to diagnose pulmonary disease. The degree of incompatibility among radiologists was assessed using SPSS statistical analysis (chi-square test).Results: The two radiologists showed slight agreement in pneumonia (29.6%), pleural effusion (28.6%), pulmonary edema (25.0%) and cardiomegaly (20.0%). Where the level of disagreement between radiologists 1 and 2 was in cardiomegaly (80.0%), pulmonary edema (75.0%) ), pneumonia (70.4%) and pleural effusion (71.4 %). The total level of agreement was 31.7% and 63.3% disagreement. This result indicates that there is a significant difference in terms of diagnosis (X2 = 8.067, p-value <0.05).Conclusion: The chest X-ray upon admission is limited in accurately diagnosing pulmonary abnormalities in hemodialysis patients, primarily due to the presence of multiple diseases in the same patient and the increased occurrence of pulmonary edema in these patients. This poses a challenge to diagnosis without clinical data or the utilization of other imaging techniques.

Clinical and Ultrasonographic Characteristics of the Achilles Tendon in Hemodialysis Patients.

Background and Objectives: The early recognition of tendon alterations in chronic hemodialysis (HD) patients, an awareness of the factors that influence the condition, and active intervention have considerable clinical relevance. The aim of this study was to investigate the musculoskeletal ultrasound (MSUS) features of the Achilles tendon in chronic HD patients and determine the factors associated with tendon abnormalities. Materials and Methods: This study was conducted on 46 HD patients and 24 sex- and age-matched controls. All participants were evaluated clinically for any signs of Achilles tendon abnormalities. Then, the Achilles tendon was scanned bilaterally using MSUS. Results: Among the 92 Achilles tendons in the HD patients, there was tenderness and swelling of only two (2.2%). Regarding MSUS features, there were statistically significant higher thicknesses in the proximal end (p < 0.001), midpoint (p < 0.001), and distal end (p < 0.001) of the Achilles tendons in the HD patients when compared with the healthy controls. Tendinosis was found in 12 (13%) of the HD patients' Achilles tendons, which was statistically significant in comparison to the healthy controls (p = 0.008). There were statistically significant higher scores of structural abnormalities (p = 0.005), bone erosions (p = 0.017), and calcifications (p = 0.015) in the HD patients when compared to the healthy controls. According to the results of a univariate regression analysis, age and male gender were predictive for US abnormalities in HD patients (p = 0.002 and 0.025, respectively). Conclusions: The Achilles tendon in subjects on chronic HD showed frequent US abnormalities. These abnormalities in HD patients appear to be more related to age and gender and may be asymptomatic.

Echocardiographic Abnormalities in Hemodialysis Patients in Togo

Echocardiographic Abnormalities in Hemodialysis Patients in Togo

Prevalence and Risk Factors for Development of Cardiac Arrhythmias and Electrocardiographic Abnormalities in Hemodialysis Patients: A Single-Center Experience in Mexico.

Prevalence and Risk Factors for Development of Cardiac Arrhythmias and Electrocardiographic Abnormalities in Hemodialysis Patients: A Single-Center Experience in Mexico.

Prevalence of Thyroid Function Abnormalities in Patients with Chronic Renal Failure under Regular Hemodialysis

Background: There are various changes in the thyroid gland and its function in end stage renal disease (ESRD). It is not surprising that impairment of kidney function leads to disturbed thyroid physiology. Objective: Is to detect thyroid function abnormalities in hemodialysis patients. Patients and Methods: 100 patients on maintenance hemodialysis (HD) were enrolled, they were excluded if they had the following criteria: history of thyroid disease, thyroid and parathyroid surgery, under interferon therapy, exposed to radiation, antithyroid drugs or thyroid replacement therapy, and those under 30 years. They were subjected to history taking, clinical examination and laboratory investigations including hepatitis C virological state, renal functions and thyroid functions. Results: 92% of patients had normal thyroid-stimulating hormone (TSH) levels, 8% had abnormal TSH levels. Regarding fT3 levels, 67 % had normal fT3 while 33 % had abnormal fT3, and only 11 patients had abnormal fT4. In respect to the thyroid hormone status, only one was hyperthyroid, 92% were in euthyroid status, 2% were clinically hypothyroid, 5% were subclinically hypothyroid, and 1% was hyperthyroid. There was significant negative correlation between TSH levels and dialysis duration, 8 patients having abnormal thyroid functions ere females, and 60% had HCV positive status. No significant associations were found between HCV infection and the thyroid hormones levels. However, HCV positive patients experienced lower levels of T4 and TSH. Conclusion: The average percentage of patients under regular hemodialysis with abnormal thyroid state is 8% with females having abnormal fT4 and TSH levels compared to males. TSH levels were inversely correlated with dialysis duration.

A synbiotic supplement for inflammation and oxidative stress and lipid abnormalities in hemodialysis patients.

Among the most important risk factors for cardiovascular disease in hemodialysis patients are high concentrations of serum inflammation markers, lipid profiles, and oxidative stress. The present study aimed to investigate the effects of a synbiotic supplement on serum systemic inflammation, oxidative stress markers, and lipid profile in hemodialysis patients. Fifty hemodialysis patients were randomly allocated to synbiotic and placebo groups. The synbiotic group received 2 tablets per day of a synbiotic supplement (100 mg) Lactobacillus coagulans and fructo-oligosaccharides for 8 weeks; whereas the placebo group received a similar appearing placebo. At the beginning and end of the study, 5 mL blood was taken after 12-14 hours of fasting. Mean values of serum C-reactive protein (hs-CRP) and malondialdehyde (MDA) significantly decreased in the synbiotic group at the end compared to the beginning of the study (P = 0.01). This reduction was significant in comparison with changes in the placebo group (P = 0.01). The synbiotic supplement also reduced serum total cholesterol (P = 0.001) and low-density lipoprotein cholesterol (LDL-c; P = 0.001) compared to the placebo group. The synbiotic supplement used improves serum hs-CRP and MDA, total cholesterol and LDL-c in hemodialysis patients, which are known risk factors for cardiovascular disease.

Ocular Manifestations in Hemodialysis Patients: Importance of Ophthalmic Examination in Prevention of Ocular Sequels.

Background:Hemodialysis (HD)-associated ocular abnormalities are one of the causes of morbidity among people undergoing HD. This study evaluates the frequency of ocular abnormalities in end-stage renal disease (ESRD) patients undergoing HD and their potential link to HD and demographic parameters.Methods:This cross-sectional study examined 242 eyes of 121 patients with ESRD undergoing regular HD after excluding the ineligible subjects. The study was designed in two parts. Medical histories of each patient including age, gender, family history, medication history, past medical history, and duration of HD collected using a structured check list. All patients underwent complete ophthalmologic examination for evaluation of the best corrected visual acuity (BCVA), intraocular pressure (IOP), and anterior and posterior segments.Results:In total, 121 patients, including 68 (56.2%) males and 53 (43.8%) females, were enrolled in the study. The mean ± SD age of the patients and their mean duration of dialysis were 51.59 ± 16.01 and 3.40 ± 2.75 years, respectively. The most prevalent etiology for HD was diabetes mellitus (39.67%), followed by hypertension (38.84%), and the most common ocular findings included cataract (142 eyes; 58.7%) and ectopic calcification of the conjunctiva and cornea (78 eyes; %32.2). There was at least one abnormal ocular finding in 89.3% of the cases. The BCVA was equal to or less than finger count in 70 eyes (28.92%). There was a significant relationship between conjunctival calcification and the duration of dialysis (P = 0.02). There was significant association between etiology of HD and conjunctival calcification (adjusted odds ratio, 2.44; 95% CI, 1.05–5.67; and P value, 0.03). Such significant associations were present for corneal calcification (P = 0.009), cataract (P = 0.02), and optic atrophy (P = 0.01).Conclusions:Regular ophthalmologic examinations are recommended due to the prevalence of clinical ocular abnormalities in HD patients.

Management of phosphate abnormalities in hemodialysis patients: Findings from Malaysia.

Studies have shown that the mean or median phosphate levels were related to certain factors although applying this finding into the clinical setting is challenging. In this study, we attempted to determine treatment characteristics for patients with end-stage renal disease (ESRD) on maintenance hemodialysis (MHD) having hyperphosphatemia or hypophosphatemia in comparison with those with normal phosphate level. This was a cross-sectional survey conducted at HD units of Central Pahang Cluster Hospitals, Malaysia, in April 2017 involving 110 ESRD patients on MHD. About 40% of the study patients had normo-or hyperphosphatemia. As many as 84.5% (n = 93) of our patients were prescribed calcium carbonate (CC); the phosphate level was not affected by phosphate binder (PB) adherence. None of our patients received more than one type of PBs. Although there were no significant differences in any factors between normo- and hyperphosphatemic patients, 64% (n = 28) of the hyperphosphatemic patients did not receive the recommended maximum PB dose. In addition, 42% (n = 30) of patients with normo- and hyperphosphatemia prescribed CC received more than the recommended daily elemental calcium. On the other hand, our hypophosphatemic patients tended to be significantly older and had lower HD duration compared to normophosphatemic patients. No other significant differences were found in medication factors between normo- and hypophos-phatemic patients. There is potential to maximize phosphate control in hyperphosphatemic patients in Malaysia by maximizing PB therapy. On the other hand, proactive supervision is required in caring and prescribing for hypophosphatemic patients, especially the older patients.

Effect of Sodium Thiosulfate on Arterial Stiffness in End-Stage Renal Disease Patients Undergoing Chronic Hemodialysis (Sodium Thiosulfate-Hemodialysis Study): A Randomized Controlled Trial

Background: Arterial stiffness (AS) and vascular calcification are significantly related to a high cardiovascular mortality risk in hemodialysis (HD) patients. Intravenous sodium thiosulfate (IV STS) can prevent and delay the vascular calcification progression in uremic states; however, the STS effect on AS has not been assessed. This study aimed to evaluate the STS efficacy on vascular calcification and AS in HD patients. Methods: Fifty HD patients with abnormal AS, as measured via the cardio-ankle vascular index (CAVI ≥8), were prospectively randomized to open-label 12.5 g IV STS during the last HD hour twice weekly for 6 months (n = 24) or the usual care (control group; n = 26). Patients and treating physicians were not blinded. The CAVI, coronary artery calcification (CAC) score, hemodynamics, and biochemical parameters were measured at the baseline and at 3 and 6 months. Results: All the baseline parameters were comparable. The IV STS significantly reduced the CAVI when compared to the control group (mean CAVI difference = –0.53; 95% CI –1.00 to –0.06; p = 0.03). A significant CAVI improvement was seen in those patients without diabetes mellitus. The natural logarithm of the CAC volume score was significantly increased in the control group. The high sensitivity C-reactive protein level was slightly lowered in the IV STS group (not significant). Conclusion: The intradialytic STS treatment significantly reduced the AS, as measured by the CAVI, and stabilized the vascular calcification in the HD patients. STS may be a novel therapeutic strategy for delaying and treating the structural and functional vascular wall abnormalities in HD patients.

The Relationship between Abdominal Aortic Calcification and Cardiac Abnormalities in Hemodialysis Patients

Background: Abdominal aortic calcification (AAC) is a marker of subclinical atherosclerotic disease and an independent predictor of subsequent vascular morbidity and mortality. Aim of the work: This study was conducted to investigate the association of abdominal aortic calcification with cardiac abnormalitiesin hemodialysispatient (HD). Methods: This cross-sectionalobservational study wasperformed on 90 patients (50 males and 40 females)with chronic kidney disease, stage 5 (CKD)of varying etiologies from hemodialysis unit at Al-Hussein UniversityHospital. They wereundergoing regularhemodialysis for more than 6 monthes.Laboratory investigations were done including liver function tests, kidney function tests,complete blood count (CBC),C-reactive protein (CRP), fasting and random blood glucose,lipid profile, calcium, phosphorus,calcium phosphate productandparathormone(PTH).In addition, Echocardiography and X-ray plain radiography were determined. Results: Out of 90 HD patients, 37 patients (41.1 %) had valvular calcification, all of them (41.1 %) had aortic valve calcifications and AAC score exceeded 6. Only 7 patients (7.8%)had mitral valve calcifications. Moreover, cases with mitral valve calcifications had aortic valve calcification and AAC score above 12. Seven patients (7.8 %) had mildaortic regurgitation (AR)and 4 patients (4.44%) had aortic stenosis. Conclusion: AAC precedes the occurrence of cardiac abnormalities in HD patients and has been shown to have significant prognostic significance for cardiovascular events and mortality.

Pulmonary Function in Patients with End-Stage Renal Disease: Effects of Hemodialysis and Fluid Overload.

BackgroundRespiratory system disorders are one of the most prevalent complications in end-stage renal disease patients on hemodialysis. However, the pathogenesis of impaired pulmonary functions has not been completely elucidated in these patients. We designed a study to investigate acute effects of hemodialysis treatment on spirometry parameters, focusing on the relationship between pulmonary function and fluid status in hemodialysis patients.Material/MethodsWe enrolled 54 hemodialysis patients in this study. Multifrequency bioimpedance analysis (BIA) was used to assess fluid status before and 30 min after the midweek of hemodialysis (HD). Overhydration (OH)/extracellular water (ECW)% ratio was used as an indicator of fluid status. Fluid overload was defined as OH/ECW ≥7%. Spirometry was performed before and after hemodialysis.ResultsForced vital capacity (FVC), FVC%, and forced expiratory volume in the first second (FEV1) levels were significantly increased after hemodialysis. FVC, FVC%, FEV1, FEV1%, mean forced expiratory flow between 25% and 75% of the FVC (FEF25–75), FEF25–75%, peak expiratory flow rate (PEFR), and PEFR% were significantly lower in patients with fluid overload than in those without. OH/ECW ratio was negatively correlated with FVC, FVC%, FEV1, FEV1%, FEF25–75, FEF25–75%, PEFR, and PEFR%. Stepwise multiple regression analysis revealed that male sex and increased ultrafiltration volume were independently associated with higher FVC, whereas increased age and OH/ECW ratio were independently associated with lower FVC.ConclusionsFluid overload is closely associated with restrictive and obstructive respiratory abnormalities in HD patients. In addition, hemodialysis has a beneficial effect on pulmonary function tests, which may be due to reduction of volume overload.

Peripheral artery disease and blood pressure profile abnormalities in hemodialysis patients.

Patients undergoing chronic hemodialysis (HD) are at increased risk for peripheral artery disease (PAD). Both ankle-brachial index (ABI) and ambulatory blood pressure monitoring (ABPM) in the interdialytic period have been shown to be strong predictors of all-cause mortality. This cross-sectional study investigated the relationship between ABPM profile and ABI in 81 HD patients. ABPM was measured throughout a 44-h midweek interdialytic period. Pre-dialysis ABI was evaluated with a BOSO ABI device. An ABI value <0.9 or ≥1.3 was defined as abnormal. In the whole study group (72% males, mean age 67±14years), there was an increase in BP (p<0.05) and in systolic BP night/day ratio (n/dSR, p=0.01) during the interdialytic period. Patients with abnormal ABI (n=29) more frequently had a positive history for cerebrovascular accident and PAD and higher proBNP values than those with normal ABI (n=52). No difference was detected among ABPM-derived components except for the n/dSR (p=0.02). Patients with abnormal ABI showed a significantly increased n/dSR (p=0.02) and ambulatory arterial stiffness index (AASI) (p=0.006) on the second day compared to the first. Patients with n/dSR >1 during day 2 (n=34) were older, showed significantly higher proBNP and AASI and were more likely to reveal abnormal ABI compared to those with a lower n/dSR (p=0.006). Abnormal ABI in HD patients is associated to changes in interdialytic ABPM pattern, namely higher n/dSR on day 2. These data may indicate the pathophysiological mechanisms underlying the worse outcome observed in HD patients.

Cross-sectional small intestinal surveillance of maintenance hemodialysis patients using video capsule endoscopy: SCHEMA study.

Background and study aims: Small intestinal pathology in hemodialysis (HD) patients has been studied in only a small number of retrospective case series. One method for noninvasively surveying small intestinal disorders is video capsule endoscopy (VCE). The primary aim of this study was to investigate the prevalence of small intestinal abnormalities among asymptomatic maintenance HD outpatients using VCE. The secondary aim was to assess the clinical impact of these abnormalities. Patients and methods: This study consisted of two phases. In phase I, a cross-sectional study, a cohort of patients who received maintenance HD three times weekly at an outpatient hemodialysis clinic were studied using VCE. Phase II was a prospective cohort study with follow up for 1 year after VCE. Results: Fifty-six patients were enrolled in this study, and two were excluded from analysis due to capsule retention in the stomach. The prevalence of small bowel abnormalities in HD patients was 64.8 % (35/54) (95 % confidential interval 52.1 % – 77.6 %). Of 54 patients, 21 (38.9 %) had mucosal lesions, 10 (18.5 %) had vascular lesions, and 4 (7.4 %) had both lesion types. During the 1-year follow-up period, events occurred in four patients. A small bowel-associated event was observed in one patient, who underwent laparoscopy-assisted small intestinal partial resection 3 months after diagnosis by VCE. All patients in whom events were seen had small bowel abnormalities; no events were observed in the VCE-negative group. Conclusions: Although asymptomatic maintenance HD patients had a high prevalence of small bowel abnormalities (64.8 %), they did not have a high incidence of small bowel-associated events during the 1-year follow-up.

Anthropometric Indicators Predict Metabolic Syndrome Diagnosis in Maintenance Hemodialysis Patients.

Obesity has been considered the key in metabolic syndrome (MetS) development, and fat accumulation may be responsible for the occurrence of metabolic abnormalities in hemodialysis patients. The use of gold-standard methods to evaluate obesity is limited, and anthropometric measures may be the simplest methods. However, no study has investigated the association between anthropometric indexes and MetS in these patients. Therefore, the aim was to determine which anthropometric indexes had the best association and prediction for MetS in patients undergoing hemodialysis. Cross-sectional study that included patients older than 18 years, undergoing hemodialysis for at least 3 months. Patients with liver disease and cancer or those receiving corticosteroids or antiretroviral therapy were excluded. Diagnostic criteria from Harmonizing Metabolic Syndrome were used for the diagnosis of MetS. Anthropometric indexes evaluated were body mass index (BMI); percent standard of triceps skinfold thickness and of middle arm muscle circumference; waist circumference (WC); sagittal abdominal diameter; neck circumference; waist-to-hip, waist-to-thigh, and waist-to-height ratios; sagittal index; conicity index; and body fat percentage. Ninety-eight patients were included, 54.1% male, and mean age was 57.8 ± 12.9 years. The prevalence of MetS was 74.5%. Individuals with MetS had increased accumulation of abdominal fat and general obesity. Waist-to-height ratio was the variable independently associated with MetS diagnosis (odds ratio, 1.21; 95% confidence interval, 1.09-1.34; P < .01) and that better predicts MetS, followed by WC and BMI (area under the curve of 0.840, 0.836, and 0.798, respectively, P < .01). Waist-to-height ratio was the best anthropometric predictor of MetS in maintenance hemodialysis patients.

0310 : Contribution of transthoracic echocardiography in chronic hemodialysis

Chronic renal failure is associated with a so-called uremic cardiomyopathy, combining morphological abnormalities and ventricular systolic and diastolic cardiac dysfunction, found in 70 to 80% of hemodialysis patients. The diagnosis of various cardiac abnormalities is an important step to identify patients at high cardiovascular risk. Describe the different echocardiographic abnormalities in hemodialysis patients and identify predictive echocardiographic parameters of death in hemodialysis. A retrospective study conducted on 92 patients undergoing hemodialysis at dialysis center of UH Ibn Rochd of Casablanca, between January 2012 and May 2014. All patients underwent transthoracic echocardiographic study. The average age of our population was 51.76 ± 14.85 years. It was composed of 49 women and 43 men with a sex ratio of 0.88.The indeterminate nephropathy was the main etiology of CRF (35.9%). The duration of dialysis was on average 5.26 ± 4.34 years. In our population, 40.2% had a dilated LV, 33.7% had systolic dysfunction and 12% had elevated filling pressures. Fourteen percent of patients had pericardial effusion, 48.9% had valvular calcification, 16.3% had aortic stenosis, 25% had PAH and 5.4% had systolic right ventricular dysfunction. In univariate analysis: Patients who died were older (p = 0.03). They had a dilated left atrium (p = 0.02), a thicker wall post (0.01), an E / Ea ratio higher (0.007), a dilated RV (0.04), an IVC more dilated (p = 0.02) and a higher SPAP (p = 0.07). None of the surviving patients had an E / Ea ratio> 15. In multivariate analysis, only the expansion of the IVC patients receiving hemodialysis were identified as independent parameter mortality (p = 0.029). Cardiac Doppler ultrasound has become not only a diagnostic tool but also a means of evaluating the effectiveness of dialysis and prognosis necessary for management of chronic hemodialysis.

Periodic Limb Movements in Sleep Contribute to Further Cardiac Structure Abnormalities in Hemodialysis Patients with Restless Legs Syndrome

In hemodialysis (HD) patients, restless legs syndrome (RLS) and periodic limb movements in sleep (PLMS) constitute common sleep disorders. Recent findings indicate a role for PLMS as a risk factor in the development of new or the aggravation of existing cardiovascular disease. The aim of the current study was to investigate the association of PLMS with indices of cardiac morphology and function in HD patients with RLS as a potential pathway by which PLMS could alter cardiovascular risk. Based on PLMS diagnosis by an overnight polysomnographic evaluation, 19 stable HD-RLS patients were divided into the PLMS group (n = 10) and the non-PLMS group (n = 9). During the overnight assessment, nocturnal blood pressure (BP) indices were also assessed. Left ventricular (LV) dimensions were examined by M-mode echocardiography, whereas LV diastolic function was evaluated by conventional Doppler and tissue Doppler imaging the following day. LV internal diameter in diastole was significantly increased in the PLMS group (4.96 ± 0.61 vs 4.19 ± 0.48 cm, p = 0.007), leading to a significantly increase in LV mass (202 ± 52 vs 150 ± 37 g, p = 0.026). In contrast, no between group differences were observed in diastolic function indices (p > 0.05). These are the first data to associate severe PLMS with further LV structure abnormalities in HD patients with RLS.

Prevalence of Anemia and Calcium-Phosphorus Abnormalities in Hemodialysis Patients in Southwestern Seoul

Young-Ki Lee, So Yoon Kim, Soo Jin Baek, Seong Nam Kim, Woo Hun Kang, Na Ree Kang, Kiwon Kim, Yong Deok Jeon, Seung Hwan Son, and Dae Joong Kim Department of Internal Medicine, Hallym Kidney institute, Hallym University College of Medicine, Seoul; Department of Medical Law and Ethics, Yonsei University College of Medicine, Seoul; Ewha Institute for Biomedical Law and Ethics, Ewha Womans University, Seoul; Seong Nam Kim Internal Medicine Clinic, Seoul; Samsung Myungin Internal Medicine Clinic, Icheon; Department of Internal Medicine, Seoul Medical Center, Seoul; Nephrology Clinic, National Cancer Center, Goyang; Department of Internal Medicine, National Medical Center, Seoul; Seung Hwan Son Internal Medicine Clinic, Seoul; Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; Dialysis Committee, Korean Society of Nephrology, Seoul, Korea

Anatomic Brain Disease in Hemodialysis Patients: A Cross-sectional Study

Although dialysis patients are at high risk of stroke and have a high burden of cognitive impairment, there are few reports of anatomic brain findings in the hemodialysis population. Using magnetic resonance imaging of the brain, we compared the prevalence of brain abnormalities in hemodialysis patients with that in a control population without known kidney disease. Cross-sectional cohort. 45 maintenance hemodialysis patients and 67 controls without reported kidney disease, both without history of known stroke. The primary predictor was dialysis status. Covariates included demographics (age, race, and sex), vascular risk factors (diabetes and hypertension), and cardiovascular disease (coronary artery disease and congestive heart failure). Magnetic resonance imaging of the brain features, including severity of white matter disease and cerebral atrophy (sulcal prominence and ventricular atrophy), hippocampal size, and small-/large-vessel infarcts. Semiquantitative scale (0-9 for white matter disease and cerebral atrophy, 0-3 for hippocampal size) and infarct prevalence. Mean ages of hemodialysis patients and controls were 55 ± 17 (SD) and 53 ± 13 years, respectively. In comparison to controls, hemodialysis patients had more severe white matter disease (1.6 vs 0.7) and cerebral atrophy (sulcal prominence, 2.3 vs 0.6; ventricular enlargement, 2.3 vs 0.9; hippocampal size, 1.3 vs 1.0), with all P < 0.001. In multivariable analyses, hemodialysis status was associated independently with worse white matter disease and atrophy grades. Hemodialysis patients also had a higher prevalence of small- (17.8%) and large- (7.8%) vessel infarcts than controls (combined, 22% vs 0%; P < 0.001). The dialysis cohort likely is healthier than the overall US hemodialysis population, partly limiting generalizability. Hemodialysis patients have more white matter disease and cerebral atrophy compared with controls without known kidney disease. Hemodialysis patients also have a high prevalence of unrecognized infarcts.