Renal Failure Undergoing Maintenance Hemodialysis Research Articles

Individualized Dietary Guidance can Help Improve Dietary Compliance in Chronic Renal Failure Patients Undergoing Maintenance Hemodialysis, Improve their Nutritional Status and Enhance their Quality of Life

This study aimed to examine the impact of individualized dietary guidance on the recovery of patients with chronic renal failure undergoing maintenance hemodialysis. This study included 124 patients undergoing maintenance hemodialysis at the Second Affiliated Hospital of Dalian Medical University between March 2020 and March 2023. The patients were divided into an observation group and a control group using a random number table method, with 62 patients in each group. Patients in the observation group received individualized dietary guidance, while those in the control group received conventional dietary guidance. After the intervention, patients in the observation group had higher Renal Adherence Behavior Questionnaire scores, transferrin, albumin, and prealbumin levels, Generic Quality of Life Inventory-74 scores, and fasting blood glucose levels than those in the control group. Furthermore, patients in the observation group had lower subjective global assessment scores, blood phosphorus levels, and incidence of hypoglycemia than those in the control group. Individualized dietary guidance can help improve dietary compliance in patients with chronic renal failure undergoing maintenance hemodialysis, improve their nutritional status, enhance the effectiveness of blood phosphorus and blood glucose management, and elevate their quality of life.

Assessment of the Thyroid Hormones in Patient with Chronic Renal Failure Undergoing Maintenance Haemodialysis in Hospital Cross Section Study

Assessment of the Thyroid Hormones in Patient with Chronic Renal Failure Undergoing Maintenance Haemodialysis in Hospital Cross Section Study

Cause of death and influencing factors of chronic renal failure on maintenance hemodialysis.

To investigate the causes of death in patients with chronic renal failure (CRF) on maintenance hemodialysis and its influencing factors. This is a retrospective study. A total of 300 patients with chronic renal failure undergoing maintenance hemodialysis who were admitted to the Affiliated Hospital of Hebei University from March 2020 to October 2022 were selected as subjects. Various information of patients were collected. In addition, 80 dead patients in this group were investigated for the cause of death, including cardiovascular and cerebrovascular diseases, infections, multi organ failure, and other causes, and the death-related conditions of cardiovascular and cerebrovascular diseases, such as triglyceridr,,total cholesterol, and in blood lipid levels were analyzed. Among the 80 dead patients, cardiovascular and cerebrovascular diseases accounted for a higher proportion of death (66%). Univariate Logistic regression analysis showed that advanced age, plasma homocysteine, blood parathyroid hormone, hyperphosphatemia, hypertension, high volume load and left ventricular hypertrophy were risk factors for death in patients with chronic renal failure on maintenance hemodialysis. Multivariate Logistic regression analysis showed that high volume load, left ventricular hypertrophy and anemia were risk factors for death on maintenance hemodialysis. The levels of hemoglobin (HGB) and high-density lipoprotein (HDL) in patients who died of cardiovascular and cerebrovascular diseases were significantly lower than those in the non-cardio-cerebrovascular death group (P=0.00), and the levels of serum phosphorus, TG and TC were significantly higher than those in the non-cardio-cerebrovascular death group (P, P=0.00; TG, P=0.02; TC, P=0.01). Cardiovascular and cerebrovascular diseases are the leading cause of death in patients with chronic renal failure on maintenance hemodialysis. Adequate dialysis and normal hemoglobin levels are favorable protective factors.

Integrin-associated ILK and PINCH1 protein content are reduced in skeletal muscle of maintenance haemodialysis patients.

Patients with renal failure undergoing maintenance haemodialysis are associated with insulin resistance and protein metabolism dysfunction. Novel research suggests that disruption to the transmembrane protein linkage between the cytoskeleton and the extracellular matrix in skeletal muscle may contribute to reduced amino acid metabolism and insulin resistance in haemodialysis. ILK, PINCH1 and pFAKTyr397 were significantly decreased in haemodialysis compared to controls, whereas Rac1 and Akt2showed no different between groups. Rac1 deletion in the Rac1 knockout model did not alter the expression of integrin-associated proteins. Phenylalanine kinetics were reduced in the haemodialysis group at 30 and 60min post meal ingestion compared to controls; both groups showed similar levels of insulin sensitivity and β-cell function. Key proteins in the integrin-cytoskeleton linkage are reduced in haemodialysis patients, suggesting for the first time that integrin-associated proteins dysfunction may contribute to reduced phenylalanine flux without affecting insulin resistance in haemodialysis patients. Muscle atrophy, insulin resistance and reduced muscle phosphoinositide 3-kinase-Akt signalling are common characteristics of patients undergoing maintenance haemodialysis (MHD). Disruption to the transmembrane protein linkage between the cytoskeleton and the extracellular matrix in skeletal muscle may contribute to reduced amino acid metabolism and insulin resistance in MHD patients. Eight MHD patients (age: 56±5years: body mass index: 32±2kgm-2 ) and non-diseased controls (age: 50±2years: body mass index: 31±1kgm-2 ) received primed continuous l-[ring-2 H5 ]phenylalanine before consuming a mixed meal. Phenylalanine metabolism was determined using two-compartment modelling. Muscle biopsies were collected prior to the meal and at 300min postprandially. In a separate experiment, skeletal muscle tissue from muscle-specific Rac1 knockout (Rac1mKO) was harvested to investigate whether Rac1 depletion disrupted the cytoskeleton-integrin linkage, allowing for cross-model examination of proteins of interest. ILK, PINCH1 and pFAKTyr397 were significantly lower in MHD (P<0.01). Rac1 and Akt showed no difference between groups for the human trial. Rac1 deletion in the Rac1mKO model did not alter the expression of integrin-associated proteins. Phenylalanine rates of appearance and disappearance, as well as metabolic clearance rates, were lower in the MHD group at 30 and 60min post meal ingestion compared to controls (P<0.05). Both groups showed similar levels of insulin sensitivity and β-cell function. Key proteins in the integrin-cytoskeleton linkage are reduced in MHD patients, suggesting for the first time that integrin-associated proteins dysfunction may contribute to reduced phenylalanine flux without affecting insulin resistance in haemodialysis patients.

Pregnant women with chronic renal failure undergoing maintenance hemodialysis: a report of three cases

Pregnant women with chronic renal failure undergoing maintenance hemodialysis: a report of three cases

Gram-negative bacterial pyomyositis in a patient with diabetes mellitus and chronic renal failure

Pyomyositis is a suppurative infection of the skeletal muscles. The predisposing conditions include immunosuppression accompanying malignancy, diabetes mellitus, renal failure, and acquired immunodeficiency syndrome, etc. We report a 49-year-old female with diabetes mellitus and chronic renal failure undergoing maintenance hemodialysis who presented with the suppurative stage of gram-negative bacterial pyomyositis due to Escherichia coli . She fully recovered following incision and drainage and appropriate antibiotic therapy. We highlight the importance of timely diagnosis of this uncommon and potentially life-threatening entity and the role of chronic renal failure and hemodialysis in causing this condition.

A Preliminary Study Revealing a New Association in Patients Undergoing Maintenance Hemodialysis: Manganism Symptoms and T1 Hyperintense Changes in the Basal Ganglia

Patients undergoing parenteral nutrition and those with portosystemic encephalopathy secondary to chronic liver disease and acquired and congenital portosystemic venous shunts frequently present manganese deposition in the basal ganglia, detected by MR imaging as hyperintense areas on T1-weighted sequences. We also observed similar abnormalities in the basal ganglia of patients with chronic renal failure undergoing maintenance hemodialysis. Our aim was to evaluate the pallidal signal intensity on T1-weighted images in a series of patients undergoing hemodialysis, with further evaluation of serum manganese levels and neurologic correlation, comparing them with patients with chronic renal failure without dialytic treatment. We performed MR imaging examinations in 9 patients with chronic renal failure, 5 of whom were undergoing hemodialysis. An experienced neuroradiologist scrutinized the presence of symmetric hyperintensities in the basal ganglia on T1-weighted sequences. We also determined the serum manganese levels and performed the neurologic evaluations in all patients. All patients undergoing hemodialysis presented elevated serum manganese levels and symmetric hyperintensities within the globus pallidus. In this group, 4 patients presented with parkinsonian symptoms, myoclonus, and syndromes with vestibular and vestibular-auditory symptoms. The patients without dialytic treatment presented with neither bilaterally increased T1 MR imaging signal intensity within the globus pallidus nor symptoms of manganism. Our preliminary results demonstrated the occurrence of bilateral pallidal hyperintensity on T1-weighted images in all patients undergoing hemodialysis associated with high serum manganese levels, revealing a new association.

Serum sulfatides as a novel biomarker for cardiovascular disease in patients with end-stage renal failure

Sulfatides, normal components of serum lipoproteins, may play an important role in cardiovascular disease due to their various modulatory functions in haemostasis. The incidence of cardiovascular disease in patients with end-stage renal failure undergoing maintenance hemodialysis has been reported to be approximately 10 to 30 times higher than that in the general population. To elucidate the possible roles of serum sulfatides in this high incidence, we measured the level of sulfatides in 59 such patients, by converting them to lysosulfatides according to a recently developed quantitative, qualitative, high-throughput technique using matrix-assisted laser desorption ionization-time of flight mass spectrometry. The mean level of sulfatides in patients 3.58 +/- 1.18 nmol/ml was significantly lower than that in age-matched normal subjects (8.21 +/- 1.50 nmol/ml; P < 0.001). Patients receiving maintenance hemodialysis over a longer period had lower levels of sulfatides. When the mean levels of sulfatides were compared between patients with cardiovascular disease (N = 22) and those without the disease (N = 37), the level in the former group 2.85 +/- 0.67 nmol/ml was found to be significantly lower than that in the latter group 4.01 +/- 1.22 nmol/ml (P < 0.001). These findings reveal a close correlation between low levels of serum sulfatides and a high risk of cardiovascular disease in these patients. Determination of the level of serum sulfatides can contribute to predictions of the incidence of cardiovascular disease in patients with end-stage renal failure undergoing maintenance hemodialysis.

Comparative study of the leachability of di(2-ethylhexyl) phthalate and tri(2-ethylhexyl) trimellitate from haemodialysis tubing

The leachability of both Di(2-ethylhexyl) phthalate (DEHP) and Tri(2-ethylhexyl) trimellitate (TEHTM) or Trioctyl trimellitate (TOTM) from haemodialysis tubing was investigated in 20 patients with chronic renal failure undergoing maintenance haemodialysis. The blood tubing made of common polyvinyl chloride (PVC) plasticized with DEHP (group 1 patients) were replaced with tubing plasticized with TOTM-DEHP (group 2 patients). The patient blood obtained from the inlet and the outlet of the dialyzer was analyzed during a 4 h-dialysis session. Thus, the circulating concentrations of both DEHP and TOTM resulting from the release from dialyzer tubes were estimated using High-performance Liquid chromatograph (HPLC). With the common PVC-DEHP blood tubing, a DEHP quantity of 122.95±33.94 mg was extracted from tubing during a single dialysis session (ranging from 55 to 166.21 mg). During the same period, the total amounts of DEHP retained by the patients were 27.30±9.22 mg (ranging from 12.50 to 42.72 mg). As for blood tubing plasticized with TOTM-DEHP, 41.80±4.47 mg of DEHP and 75.11±25.72 mg of TOTM were extracted. During the same period, the amounts of DEHP and TOTM retained by the patients were 3.42±1.37 mg and 4.87±2.60 mg, respectively. The extraction rate both plasticizers was correlated with serum lipid content (cholesterol+triglyceride) ( r 2=0.75 for DEHP and r 2=0.64 for TOTM). In the present investigation, less TOTM and DEHP were apparently released from haemodialysis tubing plasticized with TOTM-DEHP than DEHP released from haemodialysis tubing plasticized with DEHP only. TOTM seems to be a superior alternative to DEHP for use in medical devices because of its potential lower leachability. To recommend it as an alternative plasticizer, its possible toxicity towards human body should be investigated before it can be used routinely. However, patients undergoing haemodialysis using tubing plasticized with DEHP only are regularly exposed to non negligible amounts of DEHP. In view of several biological effects previously reported, it is time to reconsider the use of DEHP only as a plasticizer.

A pharmacokinetic interpretation of increasing concentrations of DEHP in haemodialysed patients

The degree of exposure to DEHP was assessed in 11 patients with chronic renal failure undergoing maintenance haemodialysis. The amount of DEHP leached from the dialyser during a 4-h dialysis session was estimated by monitoring the DEHP blood concentration using a HPLC method. When a patient undergoes a dialysis treatment, the concentration of di-2-ethylhexyl phthalate (DEHP) in venous blood is increased when the blood crosses through the dialysis apparatus. This increase may be explained either because DEHP is not extracted by the dialyser or because DEHP comes from the dialysis bath due to contact of blood against plasticized pipes. To explain the increasing concentration of DEHP during treatment of renal failure using plasticized tubing, we propose a pharmacokinetic compartmental model in order to fit raw data obtained from dialysed patients and to get the amount of DEHP which enters the body by AUC calculations. Results obtained after HPLC analysis show a high degree of interpatient variability in DEHP retained. This amount can reach a toxicity level because of repetitive dialysis treatments over prolonged periods of time. In the coming years, it seems necessary to reconsider the use of DEHP as a plasticizer in medical devices. Highly unacceptable amounts of DEHP leached during the dialysis session could be easily avoided by careful selection of haemodialysis tubing.

Radiologic diagnosis of the kidneys in dialysis patients

The kidneys of patients with chronic renal failure undergoing maintenance hemodialysis may show different variances or complications. Most common are secondarily acquired renal cysts, which may be found in as many as 92% of patients after 8 years of hemodialysis. Single (in 12.5% of patients) or multiple (8.3%) cysts with bleeding are common; additionally, hematuria or ruptured cysts may be found. Bleeding into cysts is more common in patients with autosomal dominant polycystic kidney disease. Due to the decreasing urinary production development of kidney stones is very uncommon, but calcifications in or around cysts can be found in 71% of patients. Kidney tumors occur 41 times more often in patients with chronic renal failure than in patients without kidney disease. We detected tumors in 4.2% of our patients on long-term dialysis. Diagnostic differentiation of the relatively slow growing and fairly late metastasizing malignant tumors from adenomas is not possible. Nevertheless, we screen our patients every 3-4 years. Computed tomography is superior to ultrasonography for this purpose, because ultrasonography lacks the necessary sensitivity in this group of patients.

Exposure of hemodialysis patients to di-2-ethylhexyl phthalate

The migration of di-2-ethylhexyl phthalate (DEHP) from dialyzers was studied in 21 patients with chronic renal failure undergoing maintenance hemodialysis. The circulating concentrations of DEHP were measured by high performance liquid chromatography in blood of patients obtained from the inlet and the outlet of the dialyzer during a 4-h dialysis session. During treatment of renal failure using plasticized tubing, the plasma level of DEHP increased. On average, an estimated 75.2 mg of DEHP was extracted from the dialyzer during a single dialysis session, with a range of 44.3–197.1 mg. On the other hand, the total amount of DEHP retained by the patient during the dialysis session was evaluated by the difference between the AUC out and the AUC in and ranged from 3.6 to 59.6 mg. The rate of extraction of DEHP from the dialyzer was correlated ( r=0.705, P<0.05) with serum lipid content (cholesterol and triglyceride). So, we confirmed that patients on hemodialysis are always regularly exposed to considerable amounts of DEHP. However, several metabolic effects have been reported in various animal species following treatment with DEHP, such as changes in lipid metabolism and in hepatic microsomal drug-metabolizing enzyme activities. DEHP is now a well-known hepatic peroxisomal proliferator in rodents and an inducer of many peroxisomal and non-peroxisomal enzymes. So, lipid metabolism modifications and hepatic changes observed in hemodialysis patients could be explained from chronic exposition to DEHP. In the coming years, it seems necessary to reconsider the use of DEHP as a plasticizer in medical devices. Highly unacceptable amounts of DEHP leached during the dialysis session could be easily avoided by careful selection of hemodialysis tubing.

31P NMR spectroscopy investigation of muscle metabolism in hemodialysis patients

Calf muscle metabolism of six patients with end-stage chronic renal failure undergoing maintenance hemodialysis and of six control subjects was studied using 31P nuclear magnetic resonance spectroscopy at 4.7 Tesla. Spectra were obtained at rest, during exercise and recovery. At rest, the inorganic phosphate, ATP and phosphocreatine concentrations, and the intracellular pH were similar in both groups of subjects. In the patients, the maximum workload achieved at the end of exercise led to a 84% and 46% depletion of phosphocreatine and ATP, respectively; under this condition, the intracellular pH fell to 6.50 +/- 0.09. In control subjects, a maximum workload caused no change in ATP concentration at the end of exercise, but a phosphocreatine depletion and an intracellular pH fall similar to those observed in the patients. Although the rate of phosphocreatine depletion during exercise was not different in the two groups of subjects, the decrease in intracellular pH was more rapid in the patients than in control subjects. At the end of maximum exercise, the rates of recovery of both phosphocreatine and intracellular pH were significantly reduced in the muscle of hemodialysis patients when compared to normal subjects. These results suggest that, in the calf muscle of hemodialysis patients, energy production via oxidative metabolism is impaired and compensated for by an increase in anaerobic glycolysis.

Factors affecting the nutritional status of patients with chronic renal failure undergoing haemodialysis

There is a high prevalence of the features of protein‐energy malnutrition among patients with chronic renal failure undergoing maintenance haemodialysis. Poor food intakes are only partly responsible. The disease state itself and renal replacement therapy are contributing factors to the development of malnutrition. Hypogeusia, anorexia and impaired digestion of nutrients have been reported. Changes in the hormonal environment may result in poor utilization and altered metabolism of nutrients. The requirements for nutrients may be different to those in normal healthy individuals. However, despite the effects of unalterable non‐dietary factors on nutrition, it is possible to manipulate dietary intakes to improve the nutritional status.

Effect of various therapeutic approaches on plasma potassium and major regulating factors in terminal renal failure

The development of life-threatening hyperkalemia poses a risk for patients with chronic preterminal renal failure. Various therapeutic options have been suggested for hyperkalemic emergencies in these patients; to date, however, no study has evaluated the relative efficacies of these measures in the presence of renal failure. Our goal was to examine the acute effects of a variety of therapeutic approaches, as well as those of hemodialysis, on plasma potassium levels in a hemodialysis population. Ten patients with terminal renal failure undergoing maintenance hemodialysis were enrolled in the study. Blood gas parameters and plasma sodium, potassium, glucose, osmolality, renin, aldosterone, epinephrine, norepinephrine, dopamine, and insulin were measured before, during, and after 60-minute infusions of bicarbonate, epinephrine, and insulin in glucose, and before, during, and after performance of regular hemodialysis for one hour. Hypertonic as well as isotonic intravenous bicarbonate (2 to 4 mmol/minute) induced a marked rise in plasma bicarbonate and pH, but failed to lower the plasma potassium level (5.66 versus 5.83 mmol/liter before and after). Epinephrine, 0.05 microgram/kg/minute administered intravenously, decreased plasma potassium only slightly from 5.57 to 5.25 mmol/liter, and five patients showed no decline. On the other hand, insulin in glucose, 5 mU/kg/minute intravenously, effectively lowered plasma potassium levels from 5.62 to 4.70 mmol/liter, and hemodialysis induced the most rapid decline from 5.63 to 4.29 mmol/liter. Plasma aldosterone was elevated before treatment; it correlated with plasma potassium and dropped during intravenous bicarbonate administration or hemodialysis. Pretreatment plasma renin activity, insulin, epinephrine, norepinephrine, and dopamine levels were generally normal. We conclude that in patients with terminal renal failure undergoing maintenance hemodialysis, intravenous bicarbonate is ineffective in lowering plasma potassium rapidly, and epinephrine is effective in only half the patients, whereas insulin in glucose is a fast and reliable form of therapy for hyperkalemic emergencies. Plasma aldosterone levels are appropriate in relationship to plasma potassium levels, and levels of other potassium-influencing hormones are generally normal.

Effect of a new anticoagulant (MD 805) on platelet activation in the hemodialysis circuit

MD 805 ((2R, 4R) 4-methyl-l-[N α-(3-methyl-1,2,3,4-tetra-hydro-8-quinoline-sulfonyl)L-arginyl]-2-piperidine carboxylic acid monohydrate), an anticoagulant, was used in patients with chronic renal failure undergoing maintenance hemodialysis, and the results were compared with those of heparin. MD 805 produced no significant increase in PF-4 which was observed on hemodialysis with heparin. Moreover, the arterio-venous difference in β-TG during hemodialysis with MD 805 was significantly lower than that during hemodialysis with heparin. MD 805, even at the small amount of 15 mg/hr, exhibited a stable antithrombin effect without marked interindividual differences in coagulation time as monitored by aPTT. Consequently, it caused no increase in the proteins released as a result of platelet activation in the hemodialysis circuit. MD 805 thus proved very useful in maintenance anticoagulation therapy for patients on hemodialysis.

High-performance liquid chromatographic determination of serum aliphatic amines in chronic renal failure

A high-performance liquid Chromatographic method has been introduced for the determination of aliphatic amines in serum as their 2,4-dinitrophenyl derivatives. The method has been applied to the estimation of ethanolamine, methylamine and dimethylamine in serum from patients with chronic renal failure undergoing maintenance haemodialysis. Significant differences in the levels of both methylamine and dimethylamine were obtained between normal subjects and uraemic patients both predialysis and postdialysis. After a dialysis treatment, the levels of these two amines were reduced to approximately 55% in the patient group. Their mean values, however, were found to be about six times the values of the normal group. The degree of removal of these substances during haemodialysis was smaller than those for urea nitrogen and creatinine. On the other hand, the mean ethanolamine level before dialysis was close to that of controls, and yet a 2.3-fold increase was observed after dialysis.

Autonomic Neuropathy

<h3>To the Editor.</h3> —We were interested to read the review by Heinrich in the February 1982Archives(142:339-344) and wish to add to his comments on autonomic insufficiency in patients receiving hemodialysis and patients with high spinal cord transection. In the former group there are a number of reports that subscribe to abnormal cardiovascular responses to autonomic testing.^1-3Closer analysis, however, indicates that in the majority of these studies only a few tests of autonomic function had been performed, often with inadequately matched controls. This makes interpretation difficult, if not impossible. We have completed a detailed study, using physiological, pharmacological, and biochemical approaches aimed at assessing cardiovascular aspects of autonomic function in patients with chronic renal failure undergoing maintenance hemodialysis. Some of these patients had regularly suffered from hemodialysis-induced hypotension. Comparisons were made with a matched group of normal subjects who were studied in a similar manner. The responses

Thyroid Hormones in Patients With Chronic Renal Failure Undergoing Maintenance Hemodialysis

Several parameters of the thyroid function were assessed in 28 patients undergoing long-term hemodialysis (HD) who were all judged to be clinically euthyroid. In comparison to normal subjects, HD patients had a mean T4 value reduced by 40% (5.9 ± 1.8 µ g/dl versus 9.8 ± 1.7 µ g/dl in the control group) and a mean T3 value decreased by 34% (95.0 ±17 compared to 144 ± 24 ng/dl). 46% of the HD patients had a serum T4 lower than 5.5 µ g/dl (inferior limit of the normal range) and 32% showed a serum T3 under 80 ng/dl. Concomitantly a lowered mean value for TBG was found in the HD group (14.3 ± 3 µ g/dl) compared to the control group (17.3 ± 4.7). TSH was significantly higher (4.6 ± 3.3 µ U/ml in the HD group versus 2.5 ± 1.9 µ U/ml in the control group). No major change was observed between the results of the thyroid function tests performed before and immediately after a dialysis treatment. No correlation was found between the length of hemodialysis and the severity of the abnormalities of the thyroid function. TRH stimulation test was done in nine of these patients and compared to a group of 12 normal subjects. The response of TSH in most HD patients was blunted giving a mean maximal increase of only 2.2 fold at the 30 min peak over the basal level compared to normal subjects who had 13.6 fold increase at the 30 min peak. In the HD group of patients serum T3 increased from 91 ± 23 ng/dl to 130 ± 30 ng/dl 90 min after TRH injection (135 ± 24 and 156 ± 34 respectively in the control group). Seven out of the nine patients reached a normal response for T3 after TRH stimulation. It is concluded that the abnormalities found in the thyroid function tests of the clinically enthyroid HD patients may reflect both alteration of the mechanisms of control of the pituitary-thyroid axis and changes in the metabolism of the thyroid hormones.

Thyroid hormones in patients with chronic renal failure undergoing maintenance hemodialysis.

Several parameters of the thyroid function were assessed in 28 patients undergoing long-term hemodialysis (HD) who were all judged to be clinically euthyroid. In comparison to normal subjects, HD patients had a mean T4 value reduced by 40% (5.9 ± 1.8 µ g/dl versus 9.8 ± 1.7 µ g/dl in the control group) and a mean T3 value decreased by 34% (95.0 ±17 compared to 144 ± 24 ng/dl). 46% of the HD patients had a serum T4 lower than 5.5 µ g/dl (inferior limit of the normal range) and 32% showed a serum T3 under 80 ng/dl. Concomitantly a lowered mean value for TBG was found in the HD group (14.3 ± 3 µ g/dl) compared to the control group (17.3 ± 4.7). TSH was significantly higher (4.6 ± 3.3 µ U/ml in the HD group versus 2.5 ± 1.9 µ U/ml in the control group). No major change was observed between the results of the thyroid function tests performed before and immediately after a dialysis treatment. No correlation was found between the length of hemodialysis and the severity of the abnormalities of the thyroid function. TRH stimulation test was done in nine of these patients and compared to a group of 12 normal subjects. The response of TSH in most HD patients was blunted giving a mean maximal increase of only 2.2 fold at the 30 min peak over the basal level compared to normal subjects who had 13.6 fold increase at the 30 min peak. In the HD group of patients serum T3 increased from 91 ± 23 ng/dl to 130 ± 30 ng/dl 90 min after TRH injection (135 ± 24 and 156 ± 34 respectively in the control group). Seven out of the nine patients reached a normal response for T3 after TRH stimulation. It is concluded that the abnormalities found in the thyroid function tests of the clinically enthyroid HD patients may reflect both alteration of the mechanisms of control of the pituitary-thyroid axis and changes in the metabolism of the thyroid hormones.