الفهرس 
Cardiovascular Disease in Hemodialysis PatientsOnly 14 pages are availabe for public view
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Abstract
Alterations in serum potassium (K) are common in patients with chronic kidney disease. Progression of chronic kidney disease is usually associated with worsening hyperkalemia that may require dialysis treatment. However, intermittent hemodialysis may result influctuating serum K levels, which at the extremes can reach pathologically high or low concentrations. Predialysis hyper and hypokalemia have been implicated as a correlate of death risk in maintenance hemodialysis (MHD) patients .(Iseki et al ;1996)
Our study was conducted on 30 patients maintained on regular hemodialysis in Abshway hospital ,El Fayoum Governorate.The aim of the study was to to assess serum potassium level in patients on regular hemodialysis and to determine its clinical impact on hemodynamic stability during the hemodialysis session,
In all patients we recorded full history and clinical examination, predialysis serum potassium (K) was measured, ECG was done before and after dialysis, postdialysis (K) also was measured, pulse and blood pressure were recorded hourly ,complete blood count and serum total calcium and magnesium were done to all the patients.
Our study found that the causes of end stage renal disease (ESRD) were : hypertension(50%), Obstructive Uropathy (16.7%),Diabetes Mellitus (10%), Polycystic kidney (3.3%),and Unknown cause (20%).
In our study we found that 93.3% of the study population are using arteriovenous fistula for hemodialysis ,and 6.7% of the patients using venous graft as an access for hemodialysis.
It was found that 23 patients (76.67%) of the study population were hyperkalemic before the session and 7 patients (23.33%) were normokalemic before the hemodialysis session, none of our patients reported to be hypokalemic before the session.
Blood pressure was measured hourly for the patients during the 4 hours of the session ,It was found that there was a gradual reduction of the blood pressure ,but it cannot be attributed only to the removal of potassium ,as many of the patients had received antihypertensive medications before and during the session , also some of them had removed fluids through ultrafiltration.
ECG was done for the patients before and after the session to compare ECG changes in relation to electrolytes particularly potassium, it was found that 11 patients (36.7%) of the study population had a reduction in the amplitude of T wave in the postdialysis ECG,it was found also that 3 patients (10%) had shortening of the QRS complex in the postdialysis ECG.and one patient(1.7%) had lengthening of QRS complex in the postdialysis ECG.
It was found that (3) patients had PVCs before and after dialysis while one patient had PVCS only after dialysis ,also one patient presented with atrial fibrillation before and after dialysis ,No other arrhythmias were detected ,. Thus, the absence of electrocardiographic changes in hyperkalaemic haemodialysis patients should be interpreted with caution. as a high total serum calcium concentration was associated with a low T wave amplitude.
Therefore, we should consider hyperkalemia as a very critical condi-tion to be aware of, especially in patients with impaired renal function and must educate emer¬gency room staff and physicians for the rele¬vance and unusual ECG manifestations of hy¬perkalemia in HD patients.
It was found that the mean calcium level in the patients ( 8.6) ±(1.1)mg/dl ,and it was found that (46.6%) of our study population were below the normal recommended range and (53.3%) of the patients within normal range of serum total calcium level .
It was found that the mean hemoglobin level was(10.3)±(1.7)gm/dl , (60%) of the patients were below the target hemoglobin level(11gm/dl), (33.33 %) of the patients had hemoglobin level within the target (11-13gm/dl), and (6.67%) of the patients had hemoglobin level above the target (13gm/dl).