El teatro infantil
4.2 Importancia del teatro infantil
Demograhic And Dialysis Characterisrics
Twenty patients were studied comprising of 9 females and 11 males (M: F ratio = 1.2: 1), while 20 apparently healthy, age and sex matched adults formed the control group. The patients were aged between 23 and 60 years with a mean ± SD of 41.95±10.79 while the controls had an age range between 22 and 60 years with a mean ± SD of 42.15±10.86. There was no statistically significant difference between the mean ages of the study and control group (p=0.96). The study group were in established CKD with a creatinine clearance ranging between 0.9 and 24ml/min/1.73m2 with a mean ± SD of 9.15±8.25ml/min/1.73m2 while the controls had creatinine clearance ranging from 96 to 149ml/min/1.73m2 with a mean ± SD of 110.70±19.56ml/min/1.73m2 as shown in table II.
Table II
Age and Creatinine Clearance of both the study patients and the control subjects.
Parameter Patients Controls P value Range Mean ± SD Range Mean ± SD
Age in years 23 - 60 41.95 ± 10.79 22 - 60 42.15 ± 10.80 0.96
Creatinine clearance ml/min
0.9 - 34 9.15 ± 8.25 96 - 114 110.7 ± 19.56 0.004*
* Indicates statistically significant difference
Figure I show the causes of CKD in the study group with diabetes mellitus, hypertension and chronic glomerulonephritis as the major causes accounting for 95% of cases.
5.0%
35.0%
30.0%
30.0%
pkd
htn
dm cgn Figure 1.Pie chart showing causes of CKD in the study group. Htn=hypertension, dm = diabetes mellitus, cgn= chronic glomerulonephritis, pkd = autosomal dominant polycystic kidney disease
Ten (50%) of the study patients were on maintenance haemodialysis for a duration ranging from 1 to 12 months with a mean ± SD of 5.0±3.91months, and six were on 3 times weekly dialysis while the remaining 4 were on twice weekly dialysis with a kt/v ranging between 1.10 and 1.42 with a mean of 1.24 ± 0.09 throughout the study period. Native arteriovenous fistula was the vascular access type in 60% of the patients, while 30% were using a central line using subclavian vein or jugular vein and the remaining 10% were using intermittent femoral vein catheterisation.
Biochemical investigations.
The serum creatinine and urea were statistically significantly higher in the studied patients as compared to the control subjects as shown in table III. Serum creatinine ranged from 225 to 975µmol/l with a mean of 459± 219.3µmol/l in the study patients and it ranged between 43 and 118µmol/l with a mean of 65.83± 19.56µmol/l in the control subjects with a p value of less than 0.001. The serum urea in the studied patients ranged between 3.5 and 37.5mmol/l with a mean of 17.59±9.65mmol/l while it ranged between 1.7 and 7.0 mmol/l with a mean of 3.77± 1.73mmol/l in the controls with a p value of less than 0.001. The serum chloride, bicarbonate, and calcium levels were statistically significantly lower in the studied patients as compared to the control subjects as shown in table III. The serum chloride in the studied patients ranged between 80 and 110mmol/l with a mean of 100.75±8.37mmol/l while that of the control subjects ranged between 93 and 107 mmol/l with a mean of 101.85±3.99mmol/l with p value of 0.022. The serum bicarbonate in the studied patients ranged from 10 to 32mmol/l with a mean of 19.8± 5.79mmol/l while in the controls it ranged between 18 and 28 mmol/l with a mean of 23.95± 2.56 with a p value of 0.003. The serum calcium in the studied patients ranged from 1.0 to 2.8mmol/l with a mean of 1.91± 0.52mmol/, while it ranged from 1.70 to 2.6mmol/l with a mean of 2.17± 0.22mmol/l in the control subjects with a p value of 0.001.There was no statistically significant difference in the serum level of potassium, sodium and albumin levels between the patients and the controls. Serum potassium ranged between
3.5 and 5.8mmol/l with a mean ± SD of 4.8±0.8mmol/l in the studied patients and it ranged between 3.4 and 5.6mmol/l with a mean ± SD of 4.12± 0.7mmol/l in the controls with p value of 0.42. The serum sodium ranged between 128 and 145mmol/l with a mean ± SD of 134.95±
4.66mmol/l in the studied patients and it ranged between 130 and 146mmol/l with a mean ± SD of 137.9± 4.7mmol/l in the controls with p value of 0.72. The serum albumin ranged from 25 and 45g/dl with a mean ± SD of 39.52± 4.96g/dl in the studied patients while it ranged between 33.9 and 57g/dl with a mean ± SD of 41.71± 4.84g/dl in the controls with p value of 0.66.
There was no statistically significant difference in the serum creatinine and urea between the predialysis and dialysis CKD patients in the study population as shown in table IV. Serum creatinine ranged from 228 to 975µmol/l with a mean of 455.4± 247.3µmol/l in the dialysis patients and it ranged between 225and 814µmol/l with a mean of 463.2± 200.9µmol/l in the predialytic patients with a p value of 0.36. The serum urea in the dialysis patients ranged between 3.5 and 35.2mmol/l with a mean of 16.57± 9.4mmol/l while it ranged between 10.6 and 37.3mmol/l with a mean of 18.6± 10.3mmol/l in the predialytic patients with a p value of 0.89. Serum potassium ranged between 3.2 and 5.8mmol/l with a mean ± SD of 4.9±0.84mmol/l in the dialysis patients and it ranged between 5.0 and 5.6mmol/l with a mean
± SD of 5.34± 0.27mmol/l in the predialytic patients and this difference is statistically significant with p value of 0.005. The serum sodium ranged between 128 and 145mmol/l with a mean ± SD of 134.95± 5.44mmol/l in the dialysis patients and it ranged between 130 and 140mmol/l with a mean ± SD of 135.5± 5.44mmol/l in the predialysis patients with p value of 0.32. The serum albumin ranged between 25.4 and 43.6g/dl with a mean ± SD of 37.84±
5.71g/dl in the dialysis patients while it ranged between 35.0 and 45.0g /dl with a mean ± SD of 41.2± 3.6g/dl in the predialysis patients with p value of 0.16.
Biochemical investigations.
Table III showing the descriptive statistics for serum concentration of urea, creatinine, electrolytes, calcium, phosphate, and albumin in the study patients as compared to that of the control subjects.
Parameter Patients Controls P value
Range Mean ± SD Range Mean ± SD
Creatinine (mol/L) (58- 116)
225 - 975 459 ± 219.3 43-118 65.83 ± 19.56 0.00*
Urea (mmol/L) (1.7 – 8.3)
3.5 – 37.3 17.59 ± 9.65 1.7-7.0 3.77 ± 1.73 0.00*
Potassium (mmol /L) (3.8 – 5.4)
3.2 -5.8 4.8 ± 0.81 3.4-5.6 4.12±4.7 0.421
Chloride (mmol/L) (98 – 108)
80-110 100.75 ± 8.37 93-107.0 101.85 ± 3.99 0.022*
Bicarbonate(mmol/L) (24 – 32)
10-32 19.8 ± 5.79 18-28.0 23.95 ± 2.56 0.003*
Sodium (mmol/L) (135 – 145)
128-145 134.95 ± 4.66 130-146 137.9 ± 4.7 0.702
Calcium (mmol/L) (2.0 – 2.6)
1.0-2.80 1.91 ± 0.52 1.70-2.6 2.17 ± 0.22 0.001*
Phosphate (mmol/L) (0.8 – 1.6)
0.8-3.1 1.38 ± 0.64 0.40-1.9 1.0 ± 0.39 0.064
Albumin (mmol/L) (35 – 52)
25.0-45 39.52 ± 4.96 33.9-57 41.71 ± 4.84 0.660
* Indicates statistically significant difference. Reference ranges are shown in the bracket.
Biochemical investigations.
Table IV showing the descriptive statistics for serum concentration of urea, creatinine, electrolytes, calcium, phosphate, and albumin in the haemodialysis patients as compared to that of the pre dialysis patients.
Parameter HD Patients PreHD patients P value
Range Mean ± SD Range Mean ± SD
Creatinine (mol/L) (58- 116)
228 -975 455.4 ± 247.3 225 - 814 463.2 ± 200.9 0.36
Urea (mmol/L) (1.7 – 8.3)
3.5 – 35.2 16.57 ± 9.40 10.6-37.3 18.6 ± 10.3 0.89
Potassium (mmol /L) (3.8 – 5.4)
3.2 -5.8 4.29 ± 0.84 5.00-5.60 5.34± 0.27 0.005*
Chloride (mmol/L) (98 – 108)
80-110 99.30 ± 8.38 88-110 102.0 ± 8.55 0.77
Bicarbonate(mmol/L) (24 – 32)
18-32 23.2 ± 3.99 10.0-24.0 16.40 ± 5.40 0.17
Sodium (mmol/L) (135 – 145)
128-145 134.95 ± 5.44 130-140 135.50 ± 5.44 0.32
Calcium (mmol/L) (2.0 – 2.6)
1.0-2.80 1.94 ± 0.60 1.30-2.60 1.90 ± 0.49 0.59
Phosphate (mmol/L) (0.8 – 1.6)
1.1-3.1 1.79 ± 0.68 0.80-1.30 0.98 ± 0.19 0.003*
Albumin (mmol/L) (35 – 52)
25.4 –43.6 37.84 ± 5.71 35.0-45.0 41.20 ± 3.60 0.16
* Indicates statistically significant difference. Reference ranges are shown in the bracket.
Haematological Indices
All the patients in the study group had anaemia, their haemoglobin ranged between 5.6 g/dl and 9.0 g/dl with a mean ± SD of 7.36g/dl ± 1.05 while the controls had Hb ranging from 14.3g/dl to 16g/dl with a mean ± SD of 14.19 g/dl ± 1.08 (P=0.03).
The degree of anaemia correlated with the severity of renal impairment as a positive correlation was found between the Hb and the creatinine clearance(r=0.64 at P value of 0.001) as shown in figure II.
Figure II Scattered plot showing correlation between creatinine clearance and haemoglobin in the study patients. Hbstdy= haemoglobin of the study patients in g/dl while crclstd =
creatinine clearance of the study patients in mls/ minute.
0.00 5.00 10.00 15.00 20.00
crclstd
6.00 7.00 8.00 9.00
hbstdy
Table V showed the red blood cell indices, the reticulocyte count and reticulocyte index in both the study patients and the control subjects and the corresponding reference values for the AKTH laboratory. The red blood cell count was statistically significantly lower in the studied group as it ranged from 2.06 x 109/L to 3.14 x 109/L with a mean ± SD of 2.73 109/L ± 0.34 while that of the controls ranged between 4.78 x 109/L and 6.32 x 109/L with a mean ± SD of 5.18 x 109/L ± 0.41 with a p value of 0.04. There was no statistically significant difference between the MCV, MCH and the MCHC of the study patients and the controls.
The MCV in the study group ranged between 86 fl and 97.5 fl with a mean of 89.46 fl ± 3.95.
The MCV in the controls ranged between 88 fl and 98 fl with a mean ± SD of 89.06 fl ±5.69 with a P value of 0.44 as shown in table v.
The MCH in the study group ranged between 27.0pg and 31.10pg with a mean ± SD of 29.98 pg ± 1.64 while that of the controls ranged between 28.6pg and 30.4pg with a mean ± SD of 29.70pg ± 2.72 and a P value of 0.87.
The MCHC of the patients in the study group ranged between 30.00 g/dl and 32.9 g/dl with a mean ± SD of 31.63 g/dl ± 1.03 and that of the control patients ranged between 29 g/dl and 33 g/dl with a mean ± SD of 31.39 g/dl ± 1.44 and a P value of 0.13.
The reticulocyte count in the study group ranged between 0.5% and 2.4% with a mean ± SD of 1.50 % ± 0.94, while that of the control group ranged between 1.4 % and 3.10 % with a mean ± SD of 1.76 % ± 0.94. The reticulocyte index ranged between 0.18% and 1.04 % with mean ± SD of 0.42 ± 0.18%, and those in the control group had a reticulocyte index ranging between 0.37 % and 1.90 % with a mean ± SD of 1.13 ± 0.46% with a p value of 0.01. While there was no statistically significant difference between the reticulocyte counts of the two groups, the reticulocyte index was statistically significant lower in the study group with a p value of 0.01 as shown in table V.
Table V red blood cell indices in patients and controls. MCV=mean corpuscular volume, MCH=mean corpuscular haemoglobin, MCHC= mean corpuscular haemoglobin concentration.
Parameter Patients Controls P value
Range Mean ± SD Range Mean ± SD
Red blood cell count (4.04 – 6.13) x 109
2.06 - 3.12 2.73 ± 0.34 4.78 - 6.32 5.18 ± 0.41 0.04*
MCV (femtolitre) (80 – 97) fl
86.0 - 97.50 89.46 ± 3.95 88.00- 98.00 89.06 ± 5.69 0.44
MCH picograms (27.0 – 31.2) pg
27.00 – 31.10 29.98 ± 1.64 28.60 – 30.40 29.70 ± 2.72 0.87
MCHC g/dl (31.8 – 35.4)
30.00 – 32.90 31.63 ± 1.03 29.00 – 33.00 31.39± 1.44 0.13
Reticulocyte count % (0.5 – 1.5)
0.5 - 2.4 1.50 0.94 1.4 – 3.10 1.76 0.94 0.65
Reticulocyte index % (0.5 – 2.5)
0.18 – 1.04 0.42 0.18 0.37 – 1.90 1.13 0.46 0.01*
* Indicate statistically significant difference. Figures in bracket indicate reference values for AKTH laboratory.
The blood picture was normocytic normochromic in 17(85%) of the patients while one each of the remaining patients had anisopoikilocytosis, microcytosis and macrocytosis. All the controls had a normocytic normochromic blood picture.
The WBC count in the study group ranged between 3.60 x 109 /L and 10.20 x 109 /L with a mean ± SD of 6.65 x 109 /L ± 1.99 x 109 /L while that of the controls was from 2.2 x 109 /L to 8.6 x 109/L with a mean of 4.38 x 109 /L ± 1.50 and this difference was not statistically
significant (P = 0.09) as shown in table VI. All the patients had WBC within the normal range. Majority of the patients had normal differential count while 2 patients had neutrophilia, one patient had lymphocytosis, and none had eosinophilia.
The study group had a platelet count which ranged between 81.00 x 109 /L and 326.00 x 109 /L with a mean ± SD of 203.65 x 109 /L ± 78.96 x 109 /L while that of the controls ranged between 111.00 x 109 /L to 289 x 109/L with a mean ± SD of 201.40 x 109 /L ± 45.28 x 109/L.
There was a statistically significant difference between the mean platelet counts of the two groups with a P value of 0.004 as shown in table VI.
Table VI showing the white blood cells and platelets count in both the study patients and control subjects. WBC = white blood cell count
Parameter Patients Controls P value
Range Mean ± SD Range Mean ± SD
WBC count X109/L (4 – 11 x 109/L)
3.60 – 10.20 6.65 1.99 2.2 – 8.6 4.38 1.50 0.09
Platelet count x109/L (150- 400 x109/L)
81.00 - 326 203.65 78.96 111.00- 289.0 201.40 45.28 0.004*
* Indicate statistically significant difference. Figures in bracket indicate reference values for AKTH laboratory.
The erythrocyte sedimentation rate and the clotting profile results in both the study patients and the control subjects were shown in table VII. The ESR of the study patients was statistically significantly higher compared to that of the controls. The ESR ranged between 10 and 121mm/hour with a mean of 42.65± 34.83mm/hour while that of the controls ranged between 2 and 65mm/hour with a mean of 14.50± 16.52 mm/hour. Within the study group the ESR in those on maintenance haemodialysis ranged from 10 to 121mm/ hr and the mean was 52mm/hr ± 43.79 while it ranged from 10 to 70 mm/ hr with a mean of 33.40mm/hr ± 21.09 in those predialysis patients and this difference was statistically significant with a p value of
0.002. The bleeding time was statistically significantly higher in the studied patients when compared to the controls and it ranged between 4 and 16 minutes in the study patients with a mean ± SD of 9.6 ± 3.7 minutes, it was prolonged in 7 of the patients. The bleeding time in the controls ranged between 2 and 6 minutes with a mean ± SD of 2.6 ± 0.74 minutes. The prothrombin time ranged between 15 and 24 seconds with a mean ± SD of 18.4 ± 4.30 seconds in the study patients while that of the control subjects ranged between 14 and 24 seconds with a mean ± SD of 16.72± 2.2 seconds and this difference was not statistically significant (P value of 0.24). The PTTK in the study patients ranged between 32 and 59 seconds with mean ± SD of 41.40 ± 8.51 seconds while the PTTK of the control subjects ranged between 23 to 56 seconds with a mean ± SD of 47.55 ± 17.24 seconds and this difference was not statistically significant with P=0.96 as shown in table VII.
Table VII showing the ESR and clotting profile in both the patients and control subjects. ESR
= erythrocyte sedimentation rate, PT= prothrombin Time, PTTK = partial thromboplastin time with kaolin.
Parameter Patients Controls P value
Range Mean ± SD Range Mean 2± SD
ESR mm/hour (
10 - 121 42.85 34.83 2 - 65 14.50 16.52 0.001*
Bleeding time minute (2 – 7)
4 - 16 9.6 3.7 2 - 6 .6 O.74 0.03*
PT seconds (11 – 16)
15 - 24 18.4 4.30 14 - 20 16.72 2.2 0.24
PTTK in seconds (36 – 50)
32 - 59 41. 40 8.51 23 - 56 44.55 6.69 0.96
* Indicate statistically significant difference. Reference ranges for AKTH are given in bracket
Bone marrow studies, Hb electrophoresis and G6PD.
Bone marrow aspirate result showed that 6(30%) of the patients had hypocellular marrow while 14(70%) had a normocellular marrow; none of the patients had hypercellular marrow.
Erythropoiesis was normoblastic in 12 (60%), microcytic in 4 (20%) micronomocytic in 2 (10%) and megaloblastic in 2 (10%).
The megakaryocytes were reported to be normal and actively budding in all but 2 patients, in whom it was reduced. Plasma cells were normal in the patients. Bone marrow iron was found to be normal in 6 (30%) patients, reduced in 10 (50%) patients but absent in 4 (20%) patients.
Two of the patients with megaloblastic marrow also had reduced bone marrow iron. None of the patients had excess iron.
Hb electrophoresis result showed that 19(95%) of the patients had Hb AA and only one had Hb AS, while 16(80%) of the control subjects had Hb AA and 4(20%) had Hb AS. All the patients and controls studied had normal G6PD status.
Iron Studies
The serum iron ranged between 15.4 and 18.20mol/L with a mean± SD of 10.8±
3.18mol/Lin the study patients while it ranged between 19.6 and 29.5mol/L with a mean of 19.6mol/L in the controls and this difference was statistically significant with a p value of 0.04. The TIBC ranged between 10.8 and 46.3mol/L with a mean of 27.40± 11.42mol/L in the study patients while it ranged between 32 and 65mol/L with a mean± SD of 46.74±
9.43mol/L and this difference was statistically significant with a p value of 0.013. The TSAT ranged between 22.3 and 59.9% with a mean± SD of 42.61± 14.08% in the study patients while it ranged between 23.5 and 64% with a mean ± 42.70± 2.72% in the control subjects. The serum ferritin ranged between 320 and 2000ng/ml with a mean± SD of 736.3±
471.36ng/ml in the study patients while it ranged between 241.74 and 279.02ng/ml with a mean ± 260.38± 2.72% in the control subjects and this difference was statistically significant
with a p value of 0.004. The serum iron was statistically significant lower in patients on haemodialysis with a range between 5.4 and 11.20 mol/L with a mean ± SD of 9.42±
2.17mol/L while the predialysis patients had a range of between 7.50 and 18.20mol/L with a mean ± SD of 12.19 ± 3.5mol/L (p=0.04). The TIBC ranged between 10.80 and 46.30mol/L with a mean± SD of 29.82mol/L in the dialysis patients as compared to a range between 19.30 and 40.30mol/L with a mean± SD of 24.98± 6.22 mol/L in the predialytic patients with a p value of 0.001.The TSAT in dialysis patients ranged between 22.4 and 50.0% with a mean of 37.20± 12.93% while in the predialysis patients it ranged between 22.3 and 59.90% with a mean± SD of 48.03± 13.34% and this difference is not statistically significant with a p value of 0.96. The serum ferritin in dialysis patient ranged between 585.0 and 2000ng/ml with a mean of 894.7± 435.1ng/ml while in the predialysis patients it ranged between 320.0 and 576.0 with a mean± SD of 478.0± 92.4ng/ml and this difference is statistically significant with a p value of 0.027. Table VIII showed the iron indices results in both the patients and controls while table IX showed the iron indices in the haemodialysis patients and the predialysis patients.
Table VIII.
Iron study parameters in patients and controls.
Parameter Patients Controls P value
Range Mean ± SD Range Mean ± SD
Serum iron (mol/L) (6.6 – 26.0)
15.4 0-18.20 10.81 ± 3.18 19.56 - 29.50 19.69 ± 4.96 0.04*
TIBC ( mol/L) (46.4 – 69.5)
10.80- 46.30 27.40 ± 11.42 32.00 - 65.00 46.74 ± 9.43 0.13
TSAT (%) (15 – 55)
22.30 -59.90 42.61±14.08 23.50 – 64.00 42.70 ± 2.72 0.35
Ferritin (ng/ml) (30 – 400)
320- 2000 736.3±471.6 241.74-279.02 260.38± 18.64 0.004*
* Indicates statistically significant difference. Figures in brackets indicate reference ranges for AKTH laboratory. TIBC = total iron-binding capacity, TSAT = transferin saturation in %.
Table IX.
Iron study parameters in the study patients comparing the dialysis and the predialysis patients.
Parameter HD Patients Pre HD patients P value
Range Mean ± SD Range Mean ± SD
Serum iron (mol/L) (6.6 – 26.0)
5.40 – 11.20 9.42 2.17 7.50 – 18.20 12.19 3.5 * 0.04
TIBC ( mol/L) (46.4 – 69.5)
10.80 – 46.30 29.82 14.95 19.30 – 40.30 24.98 6.22 *0.001
TSAT (%) (15 – 55)
22.40 – 50.00 37.20 12.93 22.30 – 59.90 48.03 13.34 0.96
Ferritin (ng/ml) (30 – 400)
585.0 – 2000 894.7 435.1 320.0 – 576.0 478.0 92.4 *0.027
* Indicates statistically significant difference. Figures in brackets indicate reference ranges for AKTH laboratory. TIBC = total iron-binding capacity, TSAT = transferin saturation in %. HD
= haemodialysis, Pre HD = predialysis
Echocardiography and Electrocardiographic (ECG) Evaluation
All the study patients had echocardiographic evaluation pre-intervention. Table X shows the descriptive statistics of the septal wall thickness in diastole (SWTD), left ventricular posterior wall thickness in diastole (PWTD), ejection fraction (EF) and shortening fraction (SF). There were no statistically significant differences in all the parameters between those on haemodialysis and those predialysis patients. However the values of SWTD and PWTD were all above the normal range in both predialysis patients and those on maintenance haemodialysis signifying the presence of left ventricular hypertrophy (LVH). The SWTD in the dialysis patients ranged from 10 to 22mm with a mean± SD of 15.27± 4.17, while the predialysis patients had a range from 8.7 to 22mm with a mean of 13.37± 3.85mm with a value of 0.56. The PWTD in the dialysis patients ranged between 7 and 19mm with a mean±
SD of 13.58± 3.94, while the predialysis patients had a range between 9 and 17mm with a mean of 13.70± 3.09mm with a p value of 0.49. The EF and SF were all within the normal limits. The EF in the dialysis patients ranged from 32 to 71% with a mean± SD of 54.9± 16%, while the predialysis patients had a range from 54 to 69% with a mean of 61.73± 5.74% with a p value of 0.10. The SF in the dialysis patients ranged from 19.3 to 41% with a mean± SD of 29.30± 10.43%, while the predialysis patients had a range from 23 to 39% with a mean of 30.43± 5.29% with a p value of 0.10. Six patients had evidence of moderate mitral valve regurgitation on Doppler study. There was ECG evidence of LVH in 9(45%) of the patients, while there was none in the rest of the patients. None of the patients studied showed ECG evidence of myocardial ischaemia on both echocardiogram and the electrocardiogram.
Evidence of unfolding of aorta on chest X-ray was present in 13(65%) of the patients. The cardio-thoracic ratio in the study group ranged from 0.5 to 0.65 with mean ± SD of 0.55 ± 0.51.
Table X:
Echocardiographic findings in the study patients.
Parameter MHD Patients Pre HD P value
SWTD (milimeter) (6 – 11 mm)
15.27 ± 4.17 13.37 ± 3.85 0.56
PWTD (milimeter) (8 – 11 mm)
13.58 ± 3.94 13.70 ± 3.09 0.49
EF (milimeter) (> 50 %)
54.90 ± 16.0 61.73 ± 5.74 0.10
SF (milimeter) (> 28 %)
29.30 ± 10.43 30.4 ± 5.29 0.12
AOT (milimeter) (20 – 37 mm)
29.59 ± 4.16 31.10 ± 4.07 0.97
LA (milimeter) (19 – 40mm)
40.10 ± 99.63 35.80 ± 10.76 0.56
SWTD = Interventricular septal wall diameter in diastole. PWTD =Left ventricular wall diameter in diastole, EF=ejection fraction SF=shortening fraction, AOT=aorta, LA=left atrium. Normal ranges are shown in bracket
.
Infection Screening
All the subjects in the control group had normal urine microscopy findings similarly, there was no growth on culture of the urine samples. Two (10%) of the patients in the study group had evidence of urinary tract infection. Klebsiella spp was grown in one of the samples while E.coli was grown in the other; both were successfully treated before intervention. Stool microscopy was negative for ova or cyst of helminths or other parasites, in both the study patients and the control subjects. Stool test for occult blood was positive in 2 patients in the
study group while it was negative in all the subjects in the control group. Blood film examination for Malaria parasite was positive in 4(20%) of the patients in the study group and it was positive in 6 (30%) of the control subjects.
Response to Erythropoietin Treatment.
All the study patients were treated with r-HuEpo, on a starting dose of 50iu/kg/week in two divided doses subcutaneously and subsequently increased according to the Hb response, which was reviewed fortnightly according to established guidelines up to the end of the study period. They all responded to the treatment with a dose dependant increase in the Hb level.
The Hb rose from a mean of 6.74 ± 0.70 g/dl at the beginning of the study to 11.64 ± 0.37 g/dl in those patients on maintenance haemodialysis. While in the predialytic CKD patients, the Hb rose from a mean of 7.64 ± 1.19 g/dl to a mean of 11.98 ± 0.45 g/dl during the period of the study.
Figure II shows the response of the Hb to the weekly doses of the r-HuEpo in both pre dialysis and maintenance haemodialysis patients. While table XI shows the weekly mean of Hb and the corresponding weekly r-HuEpo doses per kilogram bodyweight.
All the patients studied reached the target Hb of 11g/dL. Those on maintenance haemodialysis reached the target Hb in the 10th week of the study, on a mean weekly r-HuEpo dose per kg body weight of 151.88 ± 27.17i.u and no further increase in the dose was required to sustain the Hb level up to the end of the study. The predialysis patients reached the target Hb in the 8th week of the study on a mean weekly dose per kg body weight of 91.85±31.12 i.u and the Hb level was sustained up to the end of the study period with no further increase in the dose as shown in table XI. This dosage was statistically significantly lower than that of the patients on haemodialysis with a p value of 0.001.