Abstract
In patients on chronic hemodialysis, incidences of opportunistic infections and cancers are very high. Therefore, early detection of these diseases is very important for maintaining the quality of life. In this regard, it is imperative to have standard distribution ranges (SDRs) for the major laboratory tests specific for hemodialysis patients in a steady state. We derived RIs, from routine test results of 1,392 patients belonging to 16 hemodialysis centers, for 25 common biochemical analytes and for 14 measurements regarding peripheral blood cells just before regular hemodialysis. We adopted the latent abnormal value exclusion method for the derivation, which features iterative exclusion of individuals with abnormal results on other analytes. After the selection process, the SDRs were computed parametrically as 95 confidence intervals using the Box-Cox power transformation method. Changes typical of chronic renal failure were observed in the majority of the analytes. The widths of pre-dialysis RIs were two or more times those of healthy individuals for creatinine (CRE), urea nitrogen (UN), inorganic phosphate (IP), Mg, amylase, and eosinophil, 1.5 times more for urate, K, MCV and reticulocyte. Peculiar low-sided shifts of RIs were noted for total bilirubin, AST, ALT, and pseudo-cholinesterase. Post-dialysis RIs for Na, K, Ca, IP, CRE, urate, and UN were reduced to narrow ranges, that are regarded as targets for optimal hemodialysis. In conclusion, setting of SDRs specific for hemodialysis patients maintained in a steady state seems to be of great clinical relevance for early detection of emerging complications and for planning an optimal hemodialysis regimen.
