A cross-sectional study was conducted on 40 CKD patients receiving routine, three-times-per-week hemodialysis sessions at Al-Azhar University Hospital, internal medicine department, hemodialysis unite, new damietta, Egypt. A control group of 40 healthy individuals with similar gender and age distributions is also included in the study.
Hemodialysis technique: was performed three times per week, the dialysis session was 4 h in duration, using conventional heparin. Vascular access was through the arterio-venous fistula. The dialyzer used was a high flux poly-sulphone with a membrane surface area suitable for each patient The blood flow rate was 300–350 ml/min with a dialysate flow rate of 500 ml/min. Ultrafiltration varied rendering to the patient's actual weight. Bicarbonate was the buffer used throughout the study for all patients.
Exclusion criteria
Individuals with illnesses that could lead to the development of polyneuropathies, such as diabetes, hypothyroidism, vitamin B12 deficiency, and alcoholics, patients with previously nonfunction AVF in the other arm of the functioning AVF, patients with permcath, and temporary catheters as vascular access, people with psychiatric illnesses, systemic inflammatory and malignant diseases, and patients taking medications that could affect their peripheral nerves, and patients who refused to participate in the study.
All included persons submitted the following: history including the duration of HD and the cause of ESKD, clinical examination including examination of arteriovenous fistula, Routine blood investigations, including CBC, blood urea, serum creatinine, parathormone, calcium, and adequacy of hemodialysis (Kt/V) was assessed using the urea kinetics index (Kt/V urea), which is a function of dialyzer urea clearance, treatment time, and urea distribution volume.
Equilibrated Kt/V formula:
$${\text{Dugirdas}}:{\text{kt}}/v = - {\text{In}}\left( {\frac{{{\text{postBUN}}}}{{{\text{preBUN}} - .03}}} \right) + \left( {\left( {4 - 3.5 \times \frac{{{\text{postBUN}}}}{{{\text{preBUN}}}}} \right) \times \frac{{{\text{UF}}}}{{{\text{weight}}}}} \right)$$
where
K is the effective clearance of urea,
t is the duration of the session, and
V is the volume of urea distribution. UF is ultrafiltration (weight loss),
W is post-dialysis weight (dry weight),
T is duration of the dialysis session.
When Kt/V is greater than or equal to 1.2, dialysis is regarded as efficient. The absolute minimum that must be maintained at all times is that. Any readings outside of that range signify an inadequate response to hemodialysis therapy.
The cutaneous silent period (CSP): The neurophysiological study was performed at neurophysiology unite of neurology department, Al-Azhar University Hospital, New Damietta, Egypt. The neurophysiological parameters were verified on the hand with AV fistula and contralateral hand. The cutaneous silent period (CSP) was provoked by electrical square pulse stimulation using standard bipolar electrodes.
The cutaneous silent period (CSP) was produced by electrical stimulations on the tip of digit II by the bipolar electrodes. (80–100 mA intensity, 0.5 ms duration, 250 ms sweeps, 30 and 10,000 Hz filters). The recording was positioned on the muscle belly of the abductor pollicis brevis. A minimum of four distinct responses were occurred to determine CSP parameters. The onset latency was documented at the beginning of voluntary muscle activity inhibition, and the late latency at the start of new muscle activity. The change among the latencies designates the duration of CSP. All participants sat in a comfortable chair in a quiet room.
Statistical analysis
The statistics were prepared, arranged, and statistically analyzed using a statistical package for social science (SPSS) version 18 (SPSS Inc., USA, Chicago, Illinois). Numerical data existed as mean ± SD (standard deviation), while categorical data were offered as frequency and percent. P value < 0.05 was considered significant for the interpretation of results. Comparison between groups was done by independent samples (t) test for two means and one-way analysis of variance for more than two means with the least significant differences, the comparison was done by ANOVA with post hoc test Turkey Multinomial logistic regression and stepwise linear regression analysis.