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Hemodiyaliz hastalarında üst ekstremite sorunları

Amaç: Arterio-venöz fistüllü (AV fistül) hemodiyaliz hastalarında üst ekstremite kas-iskelet sistemi sorunla- rının araştırılması; hastalarla normal popülasyonun ve fistüllü kolla fistülsüz kolun fonksiyonel yeterlilik, ağrı ve hastalık sıklığı yönünden karşılaştırılması. Materyal ve Metot: Çalışma grubunu AV fistüllü hemodiyaliz hastaları, kontrol grubunu tanı almış her- hangi bir böbrek hastalığı olmayan gönüllüler oluşturdu. Katılımcıların yaş, cinsiyet, meslek, diyalize girme süresi ve ek hastalıkları sorgulanarak kaydedildi. Üst ekstre- mite şikayetlerine yönelik anemnezleri alınarak fizik muayeneleri yapıldı. Fizik muayene sonrası, gerekli görülen hastalara tanıya yönelik görüntüleme ve nörofizyolojik testler uygulandı. Ağrı analizleri Görsel Analog Skala (VAS) ile, üst ekstremite yetersizlikleri Kol, Omuz ve El Sorunları Anketi (DASH) ile sorgulandı. Bulgular: Çalışma grubu 150, kontrol grubu 130 kişiden oluştu. Yaş ortalaması çalışma grubunda 54,03±15,92, kontrol grubunda 54,88±15,78 yıldı. Fistül açılma süresi 4,19±2,98 yıldı. Çalışma grubunda DASH 20,60±15,61, VAS 2,08±2,06; kontrol grubunda DASH 5,63±10,35, VAS 0,44±1,31 olarak bulundu (p

(Upper extremity problems in hemodialysis patients)

ABSTRACT Background: The aim of this study was to investigate upper extremity musculoskeletal problems in hemodialysis patients with arteriovenous fistula (AV fistula); and also to compare the arm with fistula with the arm without fistula based on the disability and pain. Material and Methods: Hemodialysis patients with AV fistula were compared with the healthy controls. The ages, gender, occupation, the duration of dialysis, patients upper extremity complaints and physical examination findings were recorded. Additional imaging and neurophysiological tests were performed when necessary. Visual Analog Scale (VAS) was used for pain analysis and Disabilities of Arm, Shoulder and Hand (DASH) Survey for upper extremity disabilities. Results: Mean age was 54.03±15.92 years in the study group (n=150) and 54.88±15.78 in the controls (n=130). Fistula formation duration was 4.19±2.98 years. In the study group DASH was 20.60±15.61, VAS was 2.08±2.06; DASH was 5.63±10.35, VAS was 0.44±1.31 (p<0.001) in the controls. The upper extremity musculoskeletal complaint and disease rates were 53%, 26% in the study group and 20%, 7% in the controls, respectively (p<0.001). The rest of the results were as follows: musculoskeletal complaints: 43%, musculoskeletal disease: 21%, DASH: 33.11±9.45 and VAS: 2.08±2.06 in the arm with fistula; musculoskeletal complaints: 24%, musculoskeletal diseases: 12%, DASH:19.51±14.72 and VAS: 1.60±1.91 in the arm without fistula (p<0.05). Conclusions: The upper extremity musculoskeletal diseases are common in the hemodialysis patients. These problems adversely affect the patients` self- sufficiency and the life quality. Furthermore, AV fistula increases the disability and the diseases of the involved arm.

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