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[Statistical analyses on over ten years survivals in Hokkaido under chronic dialysis therapy]
Insights
Long-term hemodialysis patients face complications like anemia and renal issues. Early intervention and specialized dialysis membranes may mitigate risks associated with beta 2-microglobulin accumulation.
Area of Science:
- Nephrology
- Internal Medicine
- Public Health
Background:
- Focuses on 305 chronic dialysis patients in Hokkaido surviving over ten years as of July 1985.
- Highlights the predominance of chronic glomerulonephritis as the underlying disease.
- Notes that 73% of patients began dialysis in their thirties.
Purpose of the Study:
- To analyze the characteristics and long-term complications of chronic dialysis patients.
- To identify factors contributing to complications in patients undergoing prolonged dialysis therapy.
Main Methods:
- Retrospective analysis of 305 long-term dialysis patients.
- Examination of patient demographics, underlying diseases, and vascular access.
- Assessment of hematocrit levels and associated complications.
Main Results:
- 93.2% utilized internal arteriovenous fistulae for blood access.
- Average hematocrit was 27.5%, with 10.8% experiencing severe anemia (Hct < 20%).
- Identified increasing frequency of renal osteodystrophy, secondary hyperparathyroidism, carpal tunnel syndrome, and hypotension with longer dialysis duration.
Conclusions:
- Severe anemia remains a significant complication in chronic dialysis.
- Long-term dialysis is associated with progressive complications, including those linked to calcium and phosphorus metabolism.
- Beta 2-microglobulin accumulation, potentially exacerbated by Cuprophane membranes, is implicated in carpal tunnel syndrome, suggesting the need for protein-permeating dialyzers.
Abstract:
In Hokkaido, there were 305 chronic dialysis patients surviving more than ten years as of July 31, 1985. All patients except for one (CAPD) have been placed under hemodialysis. About 73% of them were introduced into a dialysis therapy in their thirties and chronic glomerulonephritis was extremely predominant as for the underlying disease. 93.2% of the cases possessed internal AV-fistulae using own vessels and other types of blood access remained only 6.8%. Hematocrit (Hct) was 27.5% on average of 305 cases. The value was fairly satisfactory but it must be noted that Hct of 33 patients (10.8% of all) was less than 20%. Severe anemia is still one of major complication in chronic dialysis patients. Characteristic complications, which have been increasing in frequency in parallel with prolonged dialysis length, became clarified: renal osteodystrophy, secondary hyperparathyroidism, carpal tunnel syndrome, persistent hypotension and so on. The former two are strongly related to Ca & P metabolism and some of the long-term survivals require parathyroidectomy. It is now estimated that carpal tunnel syndrome is induced by accumulation and deposition of beta 2-microglobulin, which increases in blood progressively if used Cuprophane membrane dialyser. Patients with CTS must be placed under surgical intervention, which relieves the symptoms effectively and the prophylaxis might require protein-permeating dialyser.