Physical Exercise of Patients on Hemodialysis, Optimistic or Pessimistic.

Chronic kidney disease leads to significant functional limitations and severe disability, which requires the application of an appropriate physical rehabilitation strategy that helps patients achieve social well-being and significant health benefits. Data sources MEDLINE, PubMed, Google Scholar and Web of Science were electronically searched, by using search terms: physical exercise, hemodialysis, barriers, risks of exercise, expected benefits. The contraindications for exercise are recent myocardial infarction, uncontrolled arrhythmia and hypertension, unstable angina pectoris, unregulated diabetes mellitus, the presence of neurological and muscular dysfunctions, malignancies, and pregnancy. The implementation of the physical exercise program for hemodialysis patients confirmed all the expected benefits: improvement of cardiovascular functions, stabilization of blood pressure, increased muscle strength, improvement of nutritional status and quality of dialysis, reduction of negative emotions, anxiety and depression, as well as social interaction of patients and their families. Despite the fact that a large number of studies have proven the beneficial effects of exercise during hemodialysis, a physical rehabilitation program as a standard form of treatment has not yet been introduced. Although there is no doubt that the effects of physical activity on the survival and the quality of life of patients on hemodialysis are positive, rehabilitation program still falls under the routine practice program in a small number of dialysis centers. One of the biggest obstacles to the implementation of the physical therapy program in hemodialysis patients is the lack of a clearly defined program that defines all the needs of dialysis patients.  DOI: 10.52547/ijkd.7570.

Ascites as First Atypical and Only Clinical Manifestation of De Novo Follicular Lymphoma.

Follicular lymphoma is the most common indolent non-Hodgkin's lymphoma and is usually initially detected in lymph nodes. Primary extranodal NHL is most commonly primarily localized in the gastrointestinal tract. We present one unusual case of ileum FL with ascites as the first clinical sign. The 73-year-old female patient was presented to the emergency department for evaluation of mild abdominal pain and abdominal swelling that had been going on for three days followed by bloating and occasional pain in the spine. The abdominal contrast-enhanced CT revealed the contrast stagnation in the distal part of the ileum. The ileum wall about 11 cm in length was thickened up to 2.9 cm and the tumor mass infiltrated all layers of ileum mesenteric lymphadenopathy up to 2 cm in diameter and significant ascites. On the upper ileum wall, the vegetative mass was described 3 cm in diameter. The patient had an emergent laparotomy with the ileocolic resection and latero-lateral ileocolic anastomosis. The microscopy finding of terminal ileum and the regional lymph nodes showed domination of cleaved cells with irregular nuclei which correspond to centrocytes. There were 0-15 large non-cleaved cells corresponding to centroblast in the microscopy high-power field. The final diagnosis was follicular lymphoma, the clinical stage 2E and histological grade by Berard and Mann criteria 1-2.

Are There Differences in Arteriovenous Fistulae Created for Hemodialysis between Nephrologists and Vascular Surgeons?

OBJECTIVE: Many studies have reported insufficient support from surgical services, resulting in nephrologists creating arteriovenous fistulas in many centers. The aim of this study was to compare risk factors of arteriovenous fistula dysfunction in patients whose fistulas were created by nephrologists versus vascular surgeons. METHODS: This was a retrospective, analytical study of interventions by nephrologists and vascular surgeons during a period of 15 years. Out of a total of 1,048 fistulas, 764 (72.9%) were created by nephrologists patients, while vascular surgeons were responsible for 284 (27.1%) fistulae. Laboratory, demographic, and clinical parameters which might affect functioning of these arteriovenous fistulae were analyzed. RESULTS: Patients whose arteriovenous fistula was formed by nephrologists differed significantly from those created by vascular surgeons in relation to the preventive character of the arteriovenous fistula (p = 0.011), lumen of the vein (p < 0.001) and systolic blood pressure (p = 0.047). Multivariate logistic regression of arteriovenous fistula dysfunction showed that risk factors were female gender (odds ratio [OR] = 1.56, 95% CI 1.16-2.07), whether the fistulae were created by vascular surgeons or nephrologists (OR = 1.38; 95% CI 1.01-1.89) and the site of the arteriovenous fistula (OR = 0.64; 95% CI 0.48-0.85). CONCLUSIONS: Arteriovenous fistulae created by vascular surgeons, female gender, and the location are risk factors of dysfunction.

Survival of Patients on Hemodialysis with Erectile Dysfunction.

Background and objectives: In patients on hemodialysis, erectile dysfunction is an independent mortality factor. This study aimed to determine the risk factors that affect the survival of hemodialysis patients with erectile dysfunction. Materials and Methods: During a seven-year period, erectile dysfunction was identified among the fatalities reported in patients receiving chronic hemodialysis, on the basis of the International Index of Erectile Function questionnaire. The study covered 70 patients of mean age 57 ± 6.7 years. During the examined period, 42 (60%) patients died at the mean age 57 ± 6.8 years. The study was completed by 28 (40%) patients, aged 57 ± 6.55 years. Laboratory, demographic, anthropometric, and clinical characteristics were recorded using standard methods. Results: Statistically significant differences between the two groups of respondents were found concerning dialysis duration (p < 0.001), number of leukocytes (p = 0.003), adequacy of hemodialysis (p = 0.004), intima media thickness of the carotid artery (p < 0.001), presence of cardiovascular disease (p = 0.03), residual diuresis (p = 0.04), and hemodiafiltration (p < 0.001). Hemodialysis adequacy (B = -9.634; p = 0.017), intima media thickness (B = 0.022; p = 0.003), residual diuresis (B = -0.060; p = 0.007), and lower rates of cardiovascular disease (B = 0.176; p = 0.034) were significant survival predictors among our patients with erectile dysfunction. Conclusions: Risk factors that are associated with improved survival of patients on hemodialysis with erectile dysfunction in our study are: preserved diuresis, high-quality hemodialysis, lower incidence of cardiovascular disease, and less thickening of the intima media of the carotid arteries.

Factors affecting the patency of arteriovenous fistulas for hemodialysis: Single center experience.

INTRODUCTION: Arteriovenous fistulas (AVFs) are the preferred form vascular access for hemodialysis (HD), as they have a low rate of complications and durable function. The aim of our investigation was to analyze the factors that might influence the function of AVFs. METHODS: Data were taken from the computerized patient record system in the Clinic of Urology and Nephrology, Clinical Center, Kragujevac, Serbia, for a 2-year period. We analyzed patients who had requested re-creation of AVFs as a secondary procedure. During this period 112 patients, 73 (65%) men and 39 (35%) women, had AVF thromboses. All relevant clinical and laboratory parameters that could affect the function and survival of AVF were evaluated. FINDINGS: In univariate logistic regression analysis, statistically significant predictors influencing the duration of the fistula were magnesium (P < 0.001), triglycerides (P = 0.041), smoking (P = 0.001), antiplatelet therapy (P < 0.001), and type of HD (bicarbonate vs. hemodiafiltration) (P < 0.001). In the multiple logistic regression model, high concentrations of magnesium (B = 7.434; P < 0.001) and antiplatelet therapy (B - 1.042; P = 0.04) were significantly associated with the length of AVF function. DISCUSSION: After successful establishment of an AVF, there is a compelling need to maintain fistula patency. Factors that affect functioning of the AVFs are presently under intense scrutiny. According to our results, some clinical factors may determine long term fistula duration, such as concentration of the magnesium and antiplatelet therapy.

Cannulation Technique and Arteriovenous Fistula Survival in Older Adult Patients on Hemodialysis.

Cannulation technique has the potential to impact arteriovenous fistula (AVF) function. The aim of this research was to determine the impact of cannulation technique on the length of the functioning AVFs in older adult patients on hemodialysis. The study included 110 participants with fistula thrombosis who had used area technique or rope ladder technique. Biochemical parameters, gender, demographic, and clinical variables were determined. Patients who used the area cannulation technique differed significantly from patients using the rope ladder technique with regard to duration of hemodialysis (p < 0.001), outcome of the AVF revision (p = 0.045), and positioning of the anastomosis (p = 0.013). The group that used the area cannulation technique had a longer duration of hemodialysis, proximal anastomoses, and more successful revisions of AVFs.

Correlation between nonalcoholic fatty liver and cardiovascular disease in elderly hemodialysis patients.

PURPOSE: The number of elderly patients with end-stage kidney disease is on the rise. Nonalcoholic fatty liver disease (NAFLD) is characterized by parenchymal fat accumulation in patients without information about alcohol abuse. The aim of our study was to determine correlation between NAFLD and cardiovascular diseases in elderly hemodialysis patients. METHODS: The examination was organized as observational and cross-sectional study in elderly patients on hemodialysis. An abdominal ultrasound examination was made in order to define NAFLD. Intima-media thickness of the carotid arteries was quantified by Doppler ultrasound. Biochemical parameters, gender, anthropometric characteristics, duration, adequacy of hemodialysis, blood pressure, smoking and cardiovascular disease were determined. Respondents were divided into a group with NAFLD (37/72 patients, 51 %) and group without NAFLD (35/72 patients, 49 %). RESULTS: Patients with NAFLD have significantly more cardiovascular disease (p = 0.017) as well as significantly higher values of intima-media thickness of the carotid arteries (p = 0.03) in correlation with patients without NAFLD. Patients without NAFLD have a statistically lower triglyceride (p = 0.04), aspartate aminotransferase (p = 0.006), alanine aminotransferase (p = 0.013) and gamma-glutamyl transpeptidase (p = 0.029) compared to patients with NAFLD. Patients with cardiovascular disease have a higher risk of NAFLD; likewise, patients with NAFLD have a three times higher chance for developing cardiovascular diseases (OR 3.01). CONCLUSION: Elderly patients on hemodialysis with cardiovascular disease have a higher risk of NAFLD; likewise, patients with NAFLD have a three times higher chance for developing cardiovascular diseases.

Is low magnesium a clue to arteriovenous fistula complications in hemodialysis?

PURPOSE: Magnesium insufficiency is a pro-atherogenic factor involved in endothelial dysfunction, atherosclerosis, and vascular calcification. Our aim was to examine the role of magnesium in the development of arteriovenous fistula complications in hemodialysis. METHODS: This was a retrospective clinical investigation of data from 88 patients who were divided into two groups: those with and without arteriovenous fistula complications. We examined the influence of sex, demographics, and clinical and laboratory parameters. The existence of fistula stenosis was determined by measuring Doppler flow, while B-mode ultrasound was used to detect plaques and evaluate the carotid artery intima-media thickness. RESULTS: Patients with arteriovenous fistula complications had significantly higher leukocyte counts (p = 0.03), platelet counts (p = 0.03), phosphate concentrations (p = 0.044), and alkaline phosphatase concentrations (p = 0.04). Patients without complications had significantly greater blood flow through the arteriovenous fistula (p < 0.0005), higher magnesium concentrations (p = 0.004), and a lower carotid artery intima-media thickness (p = 0.037). The magnesium level was inversely correlated with leukocyte (p = 0.028) and platelet (p = 0.016) counts. The magnesium concentration was significantly lower in patients with carotid artery plaques (p = 0.03). Multiple linear regression, using magnesium as the dependent variable in patients with arteriovenous fistula complications, indicated statistically significant correlations with platelet (p = 0.005) and leukocyte (p = 0.027) counts and carotid plaques (p = 0.045). CONCLUSIONS: Hypomagnesemia is a significant pro-atherogenic factor and an important predictor of arteriovenous fistula complications.

The reliability of body mass index in the diagnosis of obesity and metabolic risk in children.

BACKGROUND: Body mass index (BMI) is the most widespread and the simplest method for the evaluation of body mass; it is often used as a sole technique in the diagnosis of obesity in children. The objective of the study was to evaluate the relationship between anthropometric and biochemical parameters and the incidence of the metabolic syndrome in obese children. METHODOLOGY: A total of 110 children, aged 2-17 years, participated in the study. No overweight children (BMI 85-95 percentiles) were included. BMI was interpreted using the 2000 Centers for Disease Control and Prevention Growth Charts. The skinfold measurements were performed using an John Bull British Indicators Ltd. calipers, and interpreted using an the reference table values. RESULTS: In addition to lower sensitivity (mentioned in several earlier studies), BMI also shows a lower specificity in the diagnosis of obesity in children: BMI showed at least 10% of non-concomitance with skinfold thickness and waist circumferences and 8% with waist-to-height ratio. In addition, subscapular skinfold thickness, waist circumference, and waist/height ratio showed stronger correlations with serum insulin levels, low-density lipoprotein cholesterol, and family history than BMI itself. CONCLUSION: The unreliability of BMI as the sole parameter for diagnosing obesity in children was found in our study. Even when overweight children were excluded from the study, the lack of specificity of BMI was demonstrated. We propose utilization of waist circumference and waist/height ratio along with the BMI for definitive diagnosis instead of relying on BMI only. In addition, waist circumference and subscapular fold thickness may be even better in estimation of metabolic risk than BMI.

Predictive parameters of survival in hemodialysis patients with restless leg syndrome.

Restless leg syndrome (RLS) affects the quality of life and survival in patients on hemodialysis (HD). The aim of this study was to determine the characteristics and survival parameters in patients on HD with RLS. This study was a non-randomized clinical study involving 204 patients on HD, of whom 71 were female and 133 were male. Symptoms of RLS were defined as positive responses to four questions comprising the criteria of RLS. We recorded the outcome of treatment, biochemical analyses, demographic, sexual, anthropometric and clinical characteristics in all study patients. Patients with RLS who completed the study had a significantly higher body mass index and lower intima-media thickness and flow through the arteriovenous fistula. Among patients with RLS who died, there were more smokers as well as higher incidences of cardiovascular disease and diabetes mellitus. Among patients with RLS who survived, there were a greater number of patients with preserved diuresis and receiving erythropoietin therapy. Patients who completed the study had significantly higher levels of hemoglobin, creatinine, serum iron and transferrin saturation. Diabetes mellitus (B = 1.802; P = 0.002) and low Kt/V (B = -5.218; P = 0.001) were major predictive parameters for survival.

Stroke and diabetic ketoacidosis--some diagnostic and therapeutic considerations.

Cerebrovascular insult (CVI) is a known and important risk factor for the development of diabetic ketoacidosis (DKA); still, it seems that the prevalence of DKA among the patients suffering CVI and its influence on stroke outcome might be underestimated. Diabetic ketoacidosis itself has been reported to be a risk factor for the occurrence of stroke in children and youth. A cerebral hypoperfusion in untreated DKA may lead to cerebral injury, arterial ischemic stroke, cerebral venous thrombosis, and hemorrhagic stroke. All these were noted following DKA episodes in children. At least some of these mechanisms may be operative in adults and complicate the course and outcome of CVI. There is a considerable overlap of symptoms, signs, and laboratory findings in the two conditions, making their interpretation difficult, particularly in the elderly and less communicative patients. Serum pH and bicarbonate, blood gases, and anion gap levels should be routinely measured in all type 1 and type 2 diabetics, regardless of symptomatology, for the early detection of existing or pending ketoacidosis. The capacity for rehydration in patients with stroke is limited, and the treatment of the cerebrovascular disease requires intensive use of osmotic and loop diuretics. Fluid repletion may be difficult, and the precise management algorithms are required. Intravenous insulin is the backbone of treatment, although its effect may be diminished due to delayed fluid replenishment. Therefore, the clinical course of diabetic ketoacidosis in patients with CVI may be prolonged and complicated.

Predictive value of serum myeloperoxidase activity for thrombosis of arteriovenous fistulas.

Myeloperoxidase is a proinflammatory protein that appears as a result of increased oxidative stress. It plays an important role in the promotion and progression of atherosclerosis. The aim of this study was to determine the importance of MPO as a predictive parameter for thrombosis of arteriovenous fistula (AVF). The study involved monitoring patients with AVFs for hemodialysis over a period of 2 years. There were 41 patients, 19 (46%) men and 22 (54%) women, with mean age of 65 ± 12.7 years. Routine laboratory analyses were carried out in all respondents, including determination of MPO concentration. Gender, demographic and anthropometrical characteristics, smoking, alcohol consumption, as well as the presence of diabetic nephropathy, as an etiological factor of kidney disease, were recorded. The group of patients who developed initial thrombosis of the AVFs had significantly different values for leukocytes (8.5 ± 3.8 vs. 7.3 ± 2.1, P = 0.024), erythrocytes (2.8 ± 0.27 vs. 3.2 ± 0.65; P = 0.019), hemoglobin (88.5 ± 81 vs. 99.1 ± 6.02; P = 0.041), and myeloperoxidase (19.3 ± 4.67 vs. 11.1 ± 4.43; P = 0.007) when compared with the group without fistula thrombosis. Diabetic nephropathy (P = 0.02) characterized the group of patients with thrombosis of the fistula. Diabetic nephropathy (B = 2.53, P = 0.049) and MPO (B = 0.03, P = 0.029) were statistically significant predictors of fistula thrombosis. In our study, MPO and diabetic nephropathy were predictors of thrombosis of the AVF.

Arteriovenous fistulas and digital hypoperfusion ischemic syndrome in patients on hemodialysis.

AIM: To determine survival parameters as well as characteristics of patients with this syndrome. METHODS: The investigation was conducted over a period of eight years, as a prospective, non-randomized, clinical study which included 204 patients, treated by chronic hemodialysis. Most patients received hemodialysis 12 h per week. As vascular access for hemodialysis all subjects had an arteriovenous fistulae. Based on surveys the respondents were divided into groups of patients with and without digital hypoperfusion ischemic syndrome. Gender, demographic and anthropometric characteristics, together with comorbidity and certain habits, were recorded. During this period 34.8% patients died. RESULTS: Patients with digital hypoperfusion ischemic syndrome were older than those without ischemia (P = 0.01). Hemodialysis treatment lasted significantly longer in the patients with digital hypoperfusion ischemic syndrome (P = 0.02). The incidence of cardiovascular disease (P < 0.001) and diabetes mellitus (P = 0.01), as well as blood flow through the arteriovenous fistula (P = 0.036), were higher in patients with digital hypoperfusion ischemic syndrome. Statistically significant differences also existed in relation to oxygen saturation (P = 0.04). Predictive parameters of survival for patients with digital hypoperfusion ischemic syndrome were: adequacy of hemodialysis (B = -3.604, P < 0.001), hypertension (B = -0.920, P = 0.018), smoking (B = -0.901, P = 0.049), diabetes mellitus (B = 1.227, P = 0.005), erythropoietin therapy (B = 1.274, P = 0.002) and hemodiafiltration (B = -1.242, P = 0.033). Kaplan-Meier survival analysis indicated that subjects with and without digital hypoperfusion ischemic syndrome differed regarding the length of survival (P < 0.001), i.e., patients with confirmed digital hypoperfusion ischemic syndrome died earlier. CONCLUSION: Survival was significantly longer in the patients without digital hypoperfusion ischemic syndrome.

Residual renal function and erectile dysfunction in patients on hemodialysis.

INTRODUCTION: Residual renal function and erectile dysfunction are important parameters of quality of life in dialysis patients. GOAL: The purpose of our investigation was to determine correlations between erectile dysfunction and residual diuresis in patients on hemodialysis. METHODS: The survey was organized as a cross-sectional study in men aged up to 65 years on hemodialysis. All respondents voluntarily completed the questionnaire of the International Index of Erectile Function (IIEF)-5. Demographic and anthropometric characteristics, the duration of dialysis, smoking, alcohol consumption, residual renal function, comorbidity, and routine biochemical parameters were determined for all patients. The adequacy of dialysis was calculated as Kt/V. Based on residual renal function, the patients were divided into a group without residual diuresis and a group with preserved residual renal function. RESULTS: Nearly two-thirds of our patients did not have preserved diuresis, while 82.8% of our respondents had erectile dysfunction. Patients with preserved residual renal function were heavier (P = 0.047) and had higher body mass index (P = 0.047), but the prevalence of cardiovascular disease (P < 0.0001) and erectile dysfunction (P < 0.0015) was lower, compared to patients without residual diuresis. The regression model also demonstrated a statistically significant relationship between the residual diuresis and the total IIEF score (b = 4.74; P < 0.001). CONCLUSION: Hemodialysis patients with preserved diuresis retain erectile function better.

Laceration of the iliac vein in a patient with a femoral catheter for hemodialysis.

Although catheters are an ideal therapeutic treatment for all patients who need hemodialysis, their placement, use may be followed by certain complications. We present a case of iliac vein lacerations in the projection of the tip of a femoral catheter for hemodialysis in a 55-year-old patient.

Correlation of mortality and location of arteriovenous fistula in hemodialysis patients.

PURPOSE: Since the type of vascular access is very important and a significant risk factor for mortality in patients on hemodialysis, the aim of our study was to determine the impact of AVF positioning on the mortality of our patients. METHODS: The survey was organized as a prospective, clinical and non-randomized study of 538 surgical interventions on 323 patients, which indicates that a large number of patients had more than one fistula. Among these patients, 120 subjects (81 (67.5%) men and 39 (32.5%) women) died during the study period. We analyzed the demographic structure, the site location and type of anastomosis for the arteriovenous fistula, artery and vein lumen and presence of instillation catheters, as well as measuring flow through the fistula and arterial blood pressure. Biochemical parameters thought to have a significant impact on survival were obtained from routine monthly analyses. RESULTS: In patients in whom infection was the cause of death, termino-terminal anastomosis was more frequently present (p=0.035). Variables that were statistically significant predictors of death were elderly individuals (Beta 0.033, p<0.001); patients whose diastolic blood pressure was low (Beta -0.028, p<0.001); and the position of the arteriovenous fistula (distal Beta -0.737, p=0.001; proximal Beta -0.581, p=0.008). Patients with a cubital fistula (p=0.001) had a significantly shorter Kaplan-Meier survival curve. CONCLUSIONS: End-to-end artery and vein connection was a significantly more common form of anastomosis in patients who died as a result of infection. Important parameters of mortality in our study were the position of the arteriovenous fistula, age, and the diastolic component of arterial blood pressure.

Intima-media thickness of carotid arteries and erectile dysfunction in hemodialysis patients.

The prevalence of erectile dysfunction (ED) in hemodialysis (HD) is extremely high. The objective of this study was to evaluate the association between the intima-media thickness of carotid arteries and ED in HD patients. The survey was organized as a cross-sectional study in men aged up to 65 years, in the HD. All respondents voluntarily completed the questionnaire of the International Index of Erectile Function-5, adjusted for the Serbian language, verified routine laboratory analysis, calculated body mass index, demographic structure, duration of dialysis, the presence of hepatotropic viruses and erythropoietin therapy, smoking and drinking alcohol, determined the quality of HD, verified significantly comorbidities and measured the intima-media thickness of carotid artery using the Doppler method. The prevalence of ED in our study was 82.2%. Erectile dysfunction significantly more prevalent in older (P = 0.001) and obese patients (P = 0.047). It is significantly represented in patients with cardiovascular disease (P = 0.006), in those who consume alcohol (P = 0.04) and patients with higher values of intima-media thickness of carotid arteries (P = 0.007). Spearman's coefficient of linear correlation (ρ=-0.34, P=0.006) and linear regression (b=-2.02, P<0.001) indicated a negative association between intima-media thickness and the International Index of Erectile Function score. The prevalence of ED in our patients was 82.2%, more common in older and obese patients, a significant determinant of alcohol consumption and cardiovascular disease. Increased thickness of the intima media of the carotid arteries was associated with a higher incidence of ED.

Impact of metabolic syndrome and malnutrition on mortality in chronic hemodialysis patients.

OBJECTIVE: Metabolic abnormalities contribute to increases in the mortality rate of patients on hemodialysis. Here, we estimate the importance and influence of metabolic syndrome and malnutrition on mortality rate. DESIGN: This was a follow-up study. METHODS: We examined the demographic characteristics of time on dialysis, body mass index, indications for hospitalization, treatment outcomes, and biochemical parameters over a 4-year period. RESULTS: Whereas 31.7% of patients had metabolic syndrome, 26.7% showed evidence of malnutrition. More than two thirds of the malnourished patients died. Many patients (46%) with malnutrition were hospitalized because of problems with vascular access, whereas hospitalization of half of the examined patients with metabolic syndrome was attributable to cardiovascular disorders. Differences between groups in the parameters of anemia, total proteins, albumin, and low-density lipoprotein cholesterol also occurred, with the lowest values in malnourished patients. Glycemia, total cholesterol, and fibrinogen were significantly higher in patients with metabolic syndrome, whereas those with malnutrition had a markedly higher concentration of C-reactive protein. The mean survival was 24 months with metabolic syndrome and 17.5 months with malnutrition, which was significantly shorter. CONCLUSIONS: More than half of the examined patients had metabolic abnormalities. Patients with malnutrition had a lower rate of survival compared with those who had metabolic syndrome. Two thirds of our malnourished patients died, and the total rate of mortality in the examined sample was 38%.

Influence of the level of renal insufficiency on endoscopic changes in the upper gastrointestinal tract.

AIM: Lesions of the gastrointestinal tract are frequent finding in uremic patients but their actual nature is not completely clear. The aim of this study was to detect any correlation between endoscopic lesions of patients with different levels of renal insufficiency. METHODS: This prospective study involved 244 cases, with dyspeptic difficulties including 124 patients in different stages of renal insufficiency, and a control group of 120 patients with normal renal function. Upper esophagogastroscopy was performed in all patients because of the appearance of dyspeptic difficulties. Helicobacter pylori infection was detected by the urease test. RESULTS: H. pylori infection (P=0.009), gastric erosions (P=0.019), gastric ulcer (P=0.002), and duodenal ulcer (P<0.001) were more common in the control group of patients. Significant negative correlations were found between the level of renal insufficiency and H. pylori infection (Kendall's tau=-0.346; P=0.003), stomach erosions (Kendall's tau=-0.272; P=0.019), stomach ulcer (Kendall's tau=-0.347; P=0.003), and duodenal ulcer (Kendall's tau=-0.531; P<0.001). CONCLUSIONS: In patients with end stage renal disease, endoscopic lesions of the gastrointestinal tract are detected less frequently in relation to patients without kidney disease.