Patients

This comparative study was carried out between July 2001 and February 2002. Sixty-two patients on regular maintenance HD in the King Fahd and Ghonaimy Dialysis Units of the Cairo University Hospital were recruited after an informed consent. Patients being prepared for renal transplantation were excluded as well as those that did not consent.

Hemodialysis Protocol

All HD patients had native arteriovenous fistula, usually in the left (nondominant) forearm, which served as the venous and return access. Dialysis machines used were Fresenius 4008B and Gambro AK90. Biocompatible polysulfone dialyzers made by Hydelena, Cairo, Egypt were used and, rarely, cuprophane dialyzers. The HD was bicarbonate-based with blood flow rates that ranged 300-400 mis per minute based on patient’s tolerability. Ultrafiltration rates were individualized for the patients, as they was based on weight gain in the interdialytic period and the patient’s known dry weight. The patients were on regular thrice- or twice-weekly HD sessions with the duration of sessions being four and six hours, respectively. They were assessed during their regular HD sessions, and detailed sociodemo-graphic data was obtained from all the recruited patients. Their case records were also retrieved to validate the accuracy of the sociodemographic data. Detailed serum chemistry, which included serum urea, creatinine, Na⁺, K⁺, HC0₃“, Ca²⁺ Po³“, albumin, globulin and total protein, was assessed in all the patients. Hemoglobin (g/dl) was also determined for all the patients. The serum urea was determined just before and 30 minutes after completion of same HD session, the volume of ultrafiltration and post­dialysis or dry weight during these sessions were also recorded. viagra soft

Adequacy of HD was assessed using second-generation Daugirdas formular, i.e.,

Kt/v = [-In (R-0.03) + (4-3.5R) * (UF/W)]

Where R = predialysis blood urea nitrogen (BUN)/postdialysis BUN, W represents post dialysis weight or patient’s dry weight in kilograms and UF, volume of ultrafiltration in Liters. This was determined for two sessions four weeks apart and the average computed.

Health-Related Quality of Life Assessment

The KPSS and SF-36 were used to assess the quality of life in these patients. The detailed scoring using the Karnofsky scale is as shown in Table 1. The maximum score of 100 implies full-functional capability without symptoms and signs of ill health, while the minimum score of 0 is assigned to patients at death. Details of the characteristics of the patients with other scores are depicted in Table 1.
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Table 1. Karnofsky Performance Status Scale

SF-36, on the other hand, utilizes a 36-item questionnaire in assessing the eight different domains. The cumulative scores for the different domains were collated for all the patients and thereafter expressed as percentages on a transformed scale using the formula:

Transformed Scale = [(Actual raw score -lowest possible score) / Possible raw score range] X100 The Arabic version of the SF-36 questionnaire was not available at the time of this study; hence, the English version was used. An interpreter fluent in both Arabic and English languages and also a member of the investigating team explained the 36-item SF-36 questionnaire to the patients who did not speak or understand English language and assisted the said patients in filling out the form. Those with a good understanding of the English language filled out their forms themselves. These were done usually during the dialysis sessions. The scores were independently collated and compared by the principal investigator and another member of the team. Where differences exist, the collation was rechecked and duly corrected. Scoring checks were done as recommended in the SF-36 interpretation manual.

All patients had HRQOL assessment done twice—at least four weeks apart—and the average scores computed. canadian pharmacy cialis

Statistical Analysis

Statistical package for social sciences (SPSS) Version 10 by Microsoft Corporation USA was used for data analysis. Values were expressed as means ± standard deviation. Pearson bivariate correlation and multiple regression analysis were used as appropriate. Multiple regression analysis was used to determine the relative contributions of the various domains of SF-36 scores to the significance observed with KPSS on bivariate correlation. It was also used to test the relationship between biochemical parameters and various HRQOL scores and determine the relative contributions of the different domains where significance exists. The higher the beta values, the more the contributions of the items considered to the observed statistical significance. P values of less than 0.05 were taken as statistically significant.