Abstract
Of 128 patients who were introduced into hemodialysis between January 1969 and June 1976 at our institutes, 62 have survived over 10 years. The cumulative survival rates were 50% for 10 years, 42% for 15 years and 25% for 17 years. Nine of them died and the causes of death were disturbence of cerebral vessels in 5 cases, hyperkalemia or sudden death in two cases, myocardial infarction in one case and sepsis after bone fracture in one case.
We analysed the state of rehabilitation with regard to symptoms and renal osteodystrophy (ROD) in 48 patients who had survived until June 1986. The state of rehabilitation was 54% in full time workers, 10% in part time workers, 19% in full time house workers and 4% in retired men. The overall rehabilitation rate was 87%.
Symptoms of ROD were pain during movement of joints, 42%; spontaneous skeletal pain, 23%; muscle weakness, 67%; and pathological fracture, 2%. Carpal tunnel syndrome (CTS) appeared in 19% of the patients. The conditions accompanying failure in rehabilitation were mainly ROD and CTS.
Both microdensitometer (MD) scores and osteocalcin (OC) levels were positively correlated with duration of hemodialysis and they were statistically significant. No correlations were found between duration of hemodialysis and other factors such as PTH, serum Al-P and serum Al levels.
Parathyroidectomy (PTX) was performed in only one case. N-PTH levels over 350pg/ml were detected in 6 cases. Three of them had symptoms of ROD, but they were treated effectively with conservative therapy.
We conclude that the MD scores and OC levels are excellent parameters of ROD in patients with over 10 years of hemodialysis. We think that PTX should be carefully applied in ROD patients and that conservative therapy should be performed at an early stage of ROD.
