Iraqi J Pharm Sci, Vol.23(1) 2014 Biochemical values in hemodialysis patients 14 Measurement of some Biochemical Values in Hemodialysis Patients in Baghdad Hiba A.Hassan *,1 * College of Health and Medical Technology , Baghdad, Iraq. Abstract One hundred of dialysis patients' mean age ( 51.18±8.28) years and one hundred healthy control group , where carried out from different hospitals of Baghdad city , during the period between November /2012 until March/2013. Blood samples were collected before dialyzing for estimation the concentration of urea, creatinine, uric acid, random blood sugar , calcium and cholesterol by enzymatic method detected spectrophotometerically. The aim of this study is to determine concentration of urea, creatinine, uric acid, RBS , calcium and cholesterol in hemodialysis patients in Baghdad . The results showed that there were highly significant increases (P<0.01) in the mean of creatinine , urea , uric acid and RBS for patients (587.86µmol/l , 25.57 mmol/l, 414.36mmol/l and 6.47mmol/l) compared to the mean of healthy control (88.60 µmol/l , 5.07mmol/l ,270.76mmol/l and 4.65mmol/l ) was detected . Also there was highly significant decrease(P< 0.01) in the mean of calcium and cholesterol for patients (1.93mmol/l and3.33mmol/l) compared to the mean of healthy control (2.34mmol/l and5.02mmol/l). It is concluded that in hemodialysis was associated with the higher levels of urea ,creatinine , uric acid and RBS with low level of cholesterol and calcium. Key words: RBS (random blood sugar), SUA (serum uric acid), Cholesterol, Urea, Creatinine. فٌ بغداد انغسَم انكهوً ندى مرضي وحَوٍةانكَم بعض انقَمقَاس هبــــا عبد انحسَن حسن ،*1 * مييت اىتقْياث اىصحيت واىطبيت ، بغذاد ، اىعشاق . الخالصة ، اىنىىستشوه ،اىناىسيىً ، تشميض اىسنش اىعشىائي في ٍصو اىبىىيلىذساست تشميض جىهش اىبىه ، اىنشياتيْيِ ، حَط ٍجَىعت ٍشاقبت صحيت ، اىتجشبت سْت وٍائت ( 5,,5 ±81,15)اىعَش ٍائت ٍِ ٍشظً غسيو اىنيً ٍتىسط .ٍشظً غسيو اىنيً تٌ جَع عيْاث اىذً قبو ..112,حتً اراس / ,11,ّفزث في ٍستشفياث ٍختيفت ٍِ ٍذيْت بغذاد ، خاله اىفتشة بيِ تششيِ اىثاّي / اىتيذً ىتقذيش تشميض جىهش اىبىه و اىنشياتيْيِ وحَط اىبىىيل واىنىىستشوه واىناىسيىً و تشميضاىسنش اىعشىائي في اى اىذييضة في (P < 0.01 ) أظهشث اىْتائج أُ هْاك صيادة مبيشة ىيغايت اعتَذث بقياسها عيً االّضيَاث وتٌ قياسها بجهاص اىَطياف اىيىّي. ىيَشظً اىعشىائياىسنش تشميضواىنشياتيْيِ وجىهش اىبىه وحَط اىبىىيل ٍتىسط (587.86µmol/l , 25.57 mmol/l, 414.36mmol/l , 6.47mmol/l) ماُ هْاك أيعا ( µmol/l , 5.07mmol/l ,270.76mmol/l and 4.65mmol/l 88.60)ٍشاقبت صحيت ٍقاسّت ٍع ٍتىسط ٍقاسّت ٍع (3.33mmol/l and 1.93mmol/l)اىنىىستشوه و اىناىسيىً ىيَشظً في ٍتىسط (P < 0.01) ٍيحىظ ىيغايت اّخفاض . (5.02mmol/l and 2.34mmol/l)ٍشاقبت صحيت ٍتىسط تشميضاىسنش قذ استْتج ٍِ اىذساست اُ غسيو اىنيً ىت عالقت ٍع اىَستىياث اىعاىيت ىجىهش اىبىه واىنشياتيْيِ وحَط اىبىىيل وو .اىعشىائي وٍع اّخفاض ٍستىي اىنىىيستشوه واىناىسيىً انبونَك ، كونَستَرول ، انغسَم انكهوً . حامض انكهمات انمفتاحَة: Introduction In medicine dialysis (from Greek dialusis meaning dissolution, dia, meaning through, and lysis , meaning loosening or splitting) is a process for removing waste and excess water from the blood, and is used primarily to provide an artificial replacement for lost kidney function in people with renal failure (1). Dialysis may be used for those with an acute disturbance in kidney function (acute kidney injury, previously acute renal failure), or progressive but chronically worsening Kidney function–a state known as chronic kidney disease stage 5 (previously chronic renal failure or end-stage renal disease). The latter form may develop over months or years, but in contrast to acute kidney injury is not usually reversible, and dialysis is regarded as a "holding measure" until a renal transplant can be performed, or sometimes as the only supportive measure in those for whom a transplant would be inappropriate (2,3) . 1 Corresponding author E-mail: hebaabdul@yahoo.com Received:22 /4/2013 Accepted: 5/1/2014 http://en.wikipedia.org/wiki/Greek_(language) http://en.wikipedia.org/wiki/Blood http://en.wikipedia.org/wiki/Renal_replacement_therapy http://en.wikipedia.org/wiki/Renal_function http://en.wikipedia.org/wiki/Renal_failure http://en.wikipedia.org/wiki/Renal_failure http://en.wikipedia.org/wiki/Acute_kidney_injury http://en.wikipedia.org/wiki/Acute_kidney_injury http://en.wikipedia.org/wiki/Chronic_kidney_disease http://en.wikipedia.org/wiki/Chronic_kidney_disease http://en.wikipedia.org/wiki/Renal_transplant http://en.wikipedia.org/wiki/Dialysis#cite_note-Pendse-2 Iraqi J Pharm Sci, Vol.23(1) 2014 Biochemical values in hemodialysis patients 15 In hemodialysis, the patient's blood is pumped through the blood compartment of a dialyzer, exposing it to a partially permeable membrane. The dialyzer is composed of thousands of tiny synthetic hollow fibers. The fiber wall acts as the semipermeable membrane. Blood flows through the fibers, dialysis solution flows around the outside of the fibers, and water and wastes move between these two solutions. (4) The cleansed blood is then returned via the circuit back to the body. Ultrafiltration occurs by increasing the hydrostatic pressure across the dialyzer membrane. This usually is done by applying a negative pressure to the dialysate compartment of the dialyzer. This pressure gradient causes water and dissolved solutes to move from blood to dialysate, and allows the removal of several litres of excess fluid during a typical 4-hour treatment. In the US, hemodialysis treatments are typically given in a dialysis center three times per week (due in the US to Medicare reimbursement rules); however, as of 2007 over 2,500 people in the US are dialyzing at home more frequently for various treatment lengths (5) .Studies have demonstrated the clinical benefits of dialyzing 5 to 7 times a week, for 6 to 8 hours. This type of hemodialysis is usually called "nocturnal daily hemodialysis", which a study has shown a significant improvement in both small and large molecular weight clearance and decrease the requirement of taking phosphate binders. (6) These frequent long treatments are often done at home while sleeping, but home dialysis is a flexible modality and schedules can be changed day to day, week to week. In general, studies have shown that both increased treatment length and frequency are clinically beneficial. (7) Patients and Methods Patients This study included (100) dialysis patients (49 male and 51 female) from different hospitals of Baghdad city( Baghdad Teaching Hospital ,surgery specialist hospital and private nursing home hospital) patients' mean age for both sex ( 51.18±8.28) years and one hundred healthy control group(46 male and 64 female). Selection of the patients depending on history of patients (included most of the patients have diabetes and excluded the patients which have other disease ) and the first time undergoing dialysis. Sample collection From each patients' before dialyzing included in this study the blood was transferred into disposable plain tube and let stand for 30 minute to clot . serum was separated by centrifugation at 3000 rpm for 5 minute ,which was collected in plain tube and kept frozen unless analyzed immediately (8) . The serum was utilized for determination of blood urea, serum creatinine, serum uric acid, serum cholesterol, serum calcium and random blood sugar during the period between November /2012 until March/2013. Commercial Kits For biochemical analysis , the following kits were used: Kits supplier Kit for determination of serum glucose Randox / united kindom Kit for determination of serum urea Biomaghreb/ Ibn Khaldoun- Tunisia Kit for determination of serum creatinine Biomaghreb/ Ibn Khaldoun- Tunisia Kit for determination of serum cholesterol Randox / united kindom Kit for determination of serum calcium Randox / united kindom Statistical analysis Suitable statistical methods were used in order to analyze and assess the results, includes the following (9) : 1- Descriptive statistics: A) Statistical tables including observed frequencies with their percentages. B) Summary statistic of the readings distribution (mean, SD, SEM, minimum and maximum). 2 – Inferential statistics: These were used to accept or reject the statistical hypotheses, they include Repeated student test (t-test) by using SPSS program version-10. Results and Discussion A. Distribution of patients and control according to mean age. The distribution of dialysis patients according to mean age is listed in table (1)shows the mean age have no significant difference( P>0.05) . But when comparing the mean age in present study with the mean age of other studies (4,10) shows decrease in the mean age .This result may be related to some environmental factors. http://en.wikipedia.org/wiki/Dialysis#cite_note-7 http://en.wikipedia.org/wiki/Dialysis#cite_note-8 http://en.wikipedia.org/wiki/Dialysis#cite_note-9 http://en.wikipedia.org/wiki/Dialysis#cite_note-10 Iraqi J Pharm Sci, Vol.23(1) 2014 Biochemical values in hemodialysis patients 16 Table (1) Distribution of studied groups according to mean age / year. NS * : Non Significant at P>0.05 B.Distribution of patients and control according to gender. In the table (2) showed a no significant differences( P>0.05) between gender for patients and control This results agree with other studies (11-13) which found no differences in the incidence and/or rate of progression of renal disease between men and women. Table (2) Distribution of studied groups according to gender groups C.S. P-value patients control gender male Count 49 46 % within gender 49% 46% F.E.P.T. P=1.000 NS ⃰⃰ female Count 51 64 % within gender 51% 64% Total Count 100 100 % within gender 100 % 100% NS * : Non Significant at P>0.05 C.Distribution of patients and control according to the mean concentration of urea , creatinine , uric acid ,RBS ,calcium and cholesterol. Table (3) shows a highly significant increase (P<0.01) in the mean concentration of urea , creatinine , uric acid and RBS in the studied groups (25.57 mmol/l , 587.86 µmol/ l , 414.36 mmol/l and 6.47mmol/l) respectively compared with control (5.07 mmol/l, 88.60 µmol/ l ,270.76 mmol/l and4.65mmol/l ) respectively. Also there was highly significant decrease(P< 0.01) in the mean of calcium and cholesterol for patients (1.93mmol/l and 3.33mmol/l) compared to the mean of healthy control (2.34mmol/l and 5.02mmol/l). Elevated creatinine and urea levels are likely evidence of decreased kidney function (3, 14,15) . While increase in uric acid may be caused secondarily by renal impairment which that the urate handling by the kidneys involves filtration at the glomerulus, reabsorption, secretion and, finally, post-secretory reabsorption at tubules which are handled by multiple organic anion transporters that have been recently identified such as the urate/anion exchanger, the human organic anion transporter and the urate transporter. Consequently, elevated serum uric acid levels—as observed in our study—may result secondary to decreased glomerular filtration, decreased tubular secretion or enhanced tubular reabsorption. Decreased urate filtration can contribute to the increased in uric acid of renal insufficiency (16,17,18) . But elevated in RBS due to most of the patients have diabetes which cause damage to the kidneys, and this condition can lead to kidney failure (19,20) . Decreased calcium in present study which found when the kidneys fail, they are unable to process and filter the blood from waste products, decreasing its ability to reabsorb calcium and leading to loss of calcium in the urine (21,22) . Serum cholesterol is often low in dialysis patients, probably because of malnutrition and chronic inflammation (23,24) . Parameters Groups No. Mean Std. Dev. Std. Error 95% C. I. for Mean Min. Max. Lower Bound Upper Bound Age Control 100 51.34 8.73 1.24 48.86 53.82 37 76 patients 100 51.18 8.28 1.17 48.83 53.53 37 71 ⃰⃰t-test for Equality of Means t d.f. Sig. (2-tailed) C.S. 0.094 98 0.925 NS ⃰⃰ file://kidney-disease/vocabulary/kidney-failure/e/5496 Iraqi J Pharm Sci, Vol.23(1) 2014 Biochemical values in hemodialysis patients 17 Table (3) Distribution of studied groups according to the mean concentration of urea , creatinine ,uric acid ,RBS, calcium and cholesterol. Parameters Groups No. Mean Std. Dev. Std. Error 95% C. I. for Mean Min. Max . Lower Bound Upper Bound Urea (mmol/l) Control 100 5.07 1.45 0.20 4.66 5.48 3.1 7.5 patients 100 25.57 7.39 1.05 23.47 27.67 14 41 Creatinine (µmol/ l) Control 100 88.60 20.91 2.96 82.66 94.54 62 124 patients 100 587.8 6 233.4 0 33.01 521.53 654.19 212 113 2 Uric Acid (mmol/l) Control 100 270.7 6 85.12 12.04 246.57 294.95 180 410 patients 100 414.3 6 96.28 13.62 387.00 441.72 204 564 R.B.S (mmol/l) Control 100 4.65 0.94 0.13 4.38 4.92 3.1 6.1 Study 100 6.47 3.16 0.45 5.57 7.37 1.4 14.7 Ca (mmol/l) Control 100 2.34 0.19 0.03 2.29 2.40 2 2.7 patients 100 1.93 0.33 0.05 1.83 2.02 1.3 2.7 Cholesterol (mmol/l) Control 100 5.02 0.96 0.14 4.75 5.29 3.2 6.47 patients 100 3.33 0.55 0.08 3.17 3.48 2.17 4.26 * HS highly significance References 1. Pendse S, Singh A, Zawada E.et al. Initiation of Dialysis. In: Handbook of Dialysis. 4 th ed. New York, NY, 2008:14– 21. 2. Iseki K and Fukiyama K. Predictors of stroke in patients receiving chronic hemodialysis. Kidney Int 1996, 50: 1672– 1675 3. 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