الفهرس 
HEMODIALYSISOnly 14 pages are availabe for public view
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Abstract
C
KD is defined as the presence of kidney damage, manifested by abnormal albumin excretion or decreased kidney function, quantified by measured or estimated glomerular filtration rate (GFR), that persists for more than 3 months. Progression of CKD is associated with a number of serious complications, including increased incidence of cardiovascular disease, hyperlipidemia, anemia and metabolic bone disease. ESRD, a continuum of CKD, is defined as irreversible kidney failure treated with dialysis or transplantation.
Hemodialysis is the most successful and most commonly used form of organ replacement therapy. Its success and worldwide use attest to its safety. Many of the acute complications of hemodialysis are not immediately life threatening, they do add to the morbidity of dialysis patients and to the overall cost of the therapy.
The complications of patients on regular hemodialysis can be divided into intradialytic complications and complications secondary to chronic renal failure.
Intradialytic complications can be classified into cardiovascular complications, neurological complications, electrolytes abnormalities, complications of anticoagulant therapy, hematological complications and complications associated with hemodialysis equipments.
This study was conducted to detect the prevalence of complications among 150 patients with end stage renal disease (ESRD) are treated with regular hemodialysis (HD) in King Abdel AL Aziz kidney center, Medina, KSA; retrospectively from Jan 2012 to Dec 2012.
As regards to co-morbidities; 42.7% were diabetic and 71.3% were hypertensive. Only 36% of the patients were obese. Most of the patients (87.3%) patients had negative virology, and the remaining (12.7%) patients had HCV, HBV and HIV infection; 13 (8.7%), 4 (2.7%) and 2 (1.3%) patients respectively.
The majority of the patients (62%) were on hemodialysis for a period ranging from 1 to 5 years. Most of the patients (77.3%) had arterio-venous fistula, 14.7% had arterio-venous graft and only 12% had permanent catheter for hemodialysis. Most of the patients (69.3%) were compliant to hemodialysis.
Among all the cardiovascular complications; left ventricular hypertrophy (LVH) was the most prevalent (77.3%) followed by valvular diseases (62%), ventricular dysfunction (42%) and ischemic heart disease (40.7%). There were insignificant associations between cardiovascular complications and the gender except for ventricular dysfunction which was significantly associated with females (p=0.044). There were highly significant associations between cardiovascular complications and the prolonged duration of hemodialysis (>10 years) (p<0.001). Most of the cardiovascular complications (Acute MI, volume overload, valvular disease, IHD, pericarditis and CVD) were significantly associated with non compliance of the patients (p=0.002, p=0.001, p=0.001, p=0.023, p= 0.014, p=0.016 respectively). Ventricular dysfunction and PVD were significantly associated with diabetes (59.4%, p<0.001 and 26.6%, p=0.01). Also there were significant associations between IHD, LVH and ventricular dysfunction and hypertension (p=0.017, p<0.001, p=0.001). Acute MI, valvular disease and peripheral vascular disease were significantly associated with obesity (p=0.001, p=0.008, p=0.037 respectively). The prevalence of infective endocarditis, CVD, pericarditis and valvular disease were significantly associated with catheter dialysis (p<0.001, p=0.001, p=0.026, p=0.042 respectively).
As regards the hematological complications; the prevalence of anemia was 46%, HIT syndrome was 0.7%, thrombotic disorders was 13.3%, bleeding disorders (12%) and thrombocytopenia (8.7%). Bleeding disorders were significantly associated with non compliance of patients and permanent catheter only (p=0.015 and p<0.001 respectively), and anemia was significantly associated only with non compliance (p=0.002).
Regarding bone disease complications; the prevalence of osteoporosis was 44%, high dynamic bone diseases (HDBD) was 42.7%, adynamic bone disease (ADB) was 14% and dialysis related amyloidosis (DRA) was 20%. Osteoprosis was significantly associated with female gender (55.3%, p=0.005), prolonged duration of HD (>10 years) (91.7%, p<0.001), non compliance (65.2%, p<0.001) and obesity (59.3%, p=0.005). High dynamic bone diseases (HDBD) were significantly associated with non compliance (56.5%, p=0.023). While dialysis related amyloidosis (DRA) was significantly associated with prolonged duration of HD (>10 years) (100%, p<0.001), aterio-venous graft access AVG (40.9%, p=0.01) and non compliance to HD (30.4%, p=0.034).
As regards the neurological complication, the prevalence of autonomic neuropathy was 69.3%, peripheral neuropathy was 51.3%, sleep disorders was 44.7%, memory disorders was 29.3%, restless leg syndrome was 15.3% and uremic encephalopathy was 2%. There were significant associations between prolonged duration of hemodialysis and each of peripheral neuropathy, autonomic neuropathy and memory disorders (83.3%, 100%, 70.8% respectively and p<0.001). All of the neurological complications were significantly associated with non compliance. Peripheral neuropathy was significantly associated with diabetes (70.3%, p<0.001). Uremic encephalopathy was significantly associated with arterio-venous graft and obesity (9.1%, p=0.036 and 5.6%, p=0.02). Autonomic encephalopathy was significantly associated with obesity (81.5%, p=0.016).
As regards to GIT complications; the most prevalent complications were large bowel syndrome (LBS) (59.3%) and gastro-esophageal reflux disease (GERD) (52%). Only GERD was significantly associated with female gender (p=0.014). There were significant associations between prolonged duration of HD and each of GERD and peptic ulcer (p<0.001 each). Peptic ulcer was significantly associated with AVG (22.7%, p=0.017), while both GIT obstruction and GIT bleeding were significantly associated with permanent catheter for dialysis (8.3%, p=0.003 and 25%, p=0.002). Each of GERD, peptic ulcer and GIT bleeding were significantly associated with non compliance (78.3% and p<0.001, 17.4% and p0.005, 10.9% and p=0.017 respectively) . GERD, peptic ulcer, intestinal obstruction and GIT bleeding were significantly associated with obesity (74.1% and p<0.001, 18.5% and p<0.001, 9.3%, p=0.045 respectively). The prevalence of peptic ulcer was significantly associated with diabetes.
Regarding the dermatological complications; the prevalence uremic pruritus was (50.7%), porphyria cutanea tarda (PCT) was 1.3%, nail changes was 36%, Xerosis was 30.7%, Eruptive xanthoma was 4.7% and finally calciphylaxsis was 2%. Nail changes, Xerosis and calciphylaxis were high significantly associated with long HD duration (100%, 91.7% and 12.5% respectively, p<0.001). Significant association between both eruptive xanthoma and nail changes, and AVG access (18.2%, p=0.005 and 54.5%, p=0.007 respectively). Uremic pruritis, calciphylaxis, PCT and nail changes were significantly associated with non-compliance to hemodialysis (73.9% & p<0.001, 6.5% and p=0.009, 4.3% and p=0.032, 50% and p=0.018 respectively). Eruptive xanthoma was significantly associated with diabetes (p=0.002) and obesity (p=0.045).
Hypotesion was the most prevalent intra-dialytic complication (46.7%) followed by headache (37.3%), fatigue (30%), muscle cramps (23.3%) and hypertension (16.7%). While the prevalence of arrhythmia was 5.3%, prevalence of seizures was 4.7% and hemorrhage was 3.3%. Arrhythmias and seizures were significantly associated with pemnant vascular access (p=0.02, 0.006 respectively). Hypotension was significantly associated with prolonged duration of HD (>10 years), while hypertension was significantly associated with hemodialysis duration of 6-10 years. Headache, fatigue, arrhythmias and seizures were significantly associated with non-compliance to hemodialysis (65.2% and p<0.001, 52.2% and p<0.001, 13% and p=0.005, 10.9% and p=0.017 respectively). Only seizures were significantly associated with obesity (9.3%, p=0.045).
As regards the prevalence of psychiatric complications; the prevalence of depression was 47.3% and anxiety was 25.3%. Depression was significantly associated with early hemodialysis (first 5 years) (53.8%, p=0.016), with non compliance (65.2%, p=0.004), and with diabetes (57.8%, p=0.027).
The prevalence of recurrent infections was 38%, of metabolic disorders was 52%, malnutrition was 35.5%, acquired cystic kidney disease was 19.3%, malignancy was 8.7% and erectile dysfunction among male patients was 74.3%. Malignancy, recurrent infections and ACKD were significantly associated with prolonged duration of dialysis of > 10 years (37.5% and p<0.001, 70.8% and p<0.001, 37.5% and p=0.008 respectively), while malnutrition was significantly associated with duration of HD of 6 to 10 years (54.5%, p=0.001). The prevalence of recurrent infections was significantly associated with permanent vascular access (66.5%, p=0.032), while malnutrition was significantly associated with AVF (40.5%, p=0.032), whereas dyslipidemia was significantly associated with AVG (86.4%, p=0.002). The prevalence of recurrent infection, ACKD, malnutrition was significantly associated with non-compliance to hemodialysis (56.5% and p=0.002, 37% and p<0.001, 58.7% and p<0.001). Dyslipidemia was significantly associated with diabetes (25.6%, p=0.025). Recurrent infections was significantly associated with obesity (55.6%, p=0.001).