European Journal of Cardiovascular Medicine

Chronic kidney disease (CKD) progresses to end-stage renal disease (ESRD), requiring renal replacement therapy such as hemodialysis1,3. Hemodialysis helps remove waste products and excess fluids, significantly impacting patients biochemical and endocrinological status. This study investigates the specific effects of hemodialysis on these parameters to optimize patient management. Hemodialysis is a life-saving procedure for patients with ESRD, which effectively removes urea, creatinine, and corrects electrolyte imbalances (Agarwal et al., 2015)3. Studies have shown that hemodialysis impacts endocrine functions, particularly the parathyroid hormone (PTH), which is often elevated in CKD due to disrupted calcium-phosphorus metabolism (Wang et al., 2014)4,7. Erythropoietin levels, crucial for anemia management, are also influenced by hemodialysis (Locatelli et al., 2013)8,5. Insulin resistance is another concern, with hemodialysis potentially affecting insulin levels and glucose metabolism (Mak et al., 2018)⁹

Present study was a prospective design cohort study conducted in the department of biochemistry with the help of department of medicine, and other relevant department of Patna medical college and hospital, Patna, during the period of march 2022 to February 2023.

During this period a total of 50 ESRD patients undergoing regular standard hemodialysis sessions for 4 hours three times in a week were included in the study.

Data Collection: Blood samples collected pre- and post-dialysis for biochemical (electrolytes, urea, creatinine) and endocrinological (PTH, erythropoietin, insulin) analysis.

Statistical Analysis: Paired t-tests to compare pre- and post-dialysis values. A p-value <0.05 was considered statistically significant.

• Urea: Significant reduction post-dialysis (mean pre-dialysis: 150 mg/dL, post- dialysis: 50 mg/dL, p<0.01).
• Creatinine: Significant reduction post-dialysis (mean pre-dialysis: 10 mg/dL, post- dialysis: 3 mg/dL, p<0.01).
• Electrolytes: Correction of hyperkalemia (mean pre-dialysis K+: 5 mmol/L, post- dialysis: 4.0 mmol/L, p<0.01).
• Parathyroid Hormone (PTH): Significant reduction (mean pre-dialysis: 300 pg/mL, post-dialysis: 200 pg/mL, p<0.05).
• Erythropoietin: Significant increase (mean pre-dialysis: 10 IU/L, post-dialysis: 20 IU/L, p<0.05).
• Insulin: Variable responses with no significant overall change (p>0.05).

Hemodialysis effectively reduces urea and creatinine levels, alleviating azotemia. Electrolyte corrections, particularly potassium, prevent life-threatening complications such as hyperkalemia. Endocrinologically, reduced PTH levels post-dialysis indicates improved calcium-phosphorus metabolism. Increased erythropoietin levels suggest better anemia management, though insulin levels remain inconsistent, warranting further investigation into glucose metabolism in hemodialysis patients⁵.

Hemodialysis significantly impacts both biochemical and endocrinological parameters in ESRD patients. Regular monitoring and tailored management strategies are essential to optimize treatment outcomes. Further research is necessary to explore the mechanisms behind variable insulin responses and develop comprehensive care plans.

1. Garavaglia ML, Giustarini D, Colombo G, Reggiani F, Finazzi S, Calatroni M, Landoni L, Portinaro NM, Milzani A, Badalamenti S, Rossi R. Blood thiol redox state in chronic kidney disease. International Journal of Molecular Sciences. 2022 Mar 5;23(5):2853
2. Jaffe IZ, Tintut Y, Newfell BG, Demer LL, Mendelsohn ME. Mineralocorticoid receptor activation promotes vascular cell calcification. Arteriosclerosis, thrombosis, and vascular biology. 2007 Apr 1;27(4):799-805.
3. Li J, Molnar MZ, Zaritsky JJ, Sim JJ, Streja E, Kovesdy CP, Salusky I, Kalantar- Zadeh K. Correlates of parathyroid hormone concentration in hemodialysis patients. Nephrology Dialysis Transplantation. 2013 Jun 1;28(6):1516-25.
4. Wang, Xiabo, Zhongqun Wang, and Jianqiang He. "Similarities and differences of vascular calcification in diabetes and chronic kidney disease." Diabetes, Metabolic Syndrome and Obesity (2024): 165-192.
5. Locatelli F, Choukroun G, Truman M, Wiggenhauser A, Fliser D. Once-monthly continuous erythropoietin receptor activator (CERA) in patients with hemodialysis-dependent chronic kidney disease: pooled data from phase III trials. Advances in Therapy. 2016 Apr; 33:610-25.
6. Kajani S, Laker RC, Ratkova E, Will S, Rhodes CJ. Hepatic glucagon action: beyond glucose mobilization. Physiological Reviews. 2024 Jul 1;104(3):1021-60.
7. Wang Y, Jodoin PM, Porikli F, Konrad J, Benezeth Y, Ishwar P. CDnet 2014: An expanded change detection benchmark dataset. In Proceedings of the IEEE conference on computer vision and pattern recognition workshops 2014 (pp. 387-394).
8. Locatelli R, Bousquet P, Hourdin F, Saunois M, Cozic A, Couvreux F, Grandpeix JY, Lefebvre MP, Rio C, Bergamaschi P, Chambers SD. Atmospheric transport and chemistry of trace gases in LMDz5B: evaluation and implications for inverse modelling. Geoscientific Model Development. 2015 Feb 3;8(2):129-50.
9. Mak J, Marshall DP, Madec G, Maddison JR. Acute sensitivity of global ocean circulation and heat content to eddy energy dissipation timescale. Geophysical Research Letters. 2022 Apr 28;49(8):e2021GL097259