الفهرس 
Respiratory musclesOnly 14 pages are availabe for public view
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Abstract
Chronic renal failure (CRF) is characterized by progressive and irreversible destruction of renal structures. The respiratory system suffers alterations in respiratory drive, pulmonary mechanics, muscle function and gas exchange. This pulmonary dysfunction may be a direct result of the circulation of toxins or, indirectly, from the excess volume due to the increased quantities of circulating body fluids, anemia, immunological suppression, drugs and deficient nutrition (David J. and Pierson, 2006).
Physiological abnormalities are frequent in the skeletal muscle structure of patients with CRF , and their main signs are fatigue, muscular weakness and low exercise tolerance Respiratory muscular weakness may lead to hypoventilation, maximum respiratory pressure measurements may help in early diagnosis and therapeutic interventions for these patients(Sala et al., 2001).
The aim of this study is to assess the respiratory muscle performance by measuring the maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) in chronic renal failure patients under conservative treatment and immediately before and after hemodialysis.
This study was carried out between Pulmonary Function Unit Chest Department and Renal Dialysis Unit in Ain Shams University Hospital in the period from January 2012 to January 2013.
Sixty patients with chronic renal failure were included in this study and they were divided in to 2 groups:
• group 1:
Thirty patients with chronic renal failure undergoing regular hemodialysis for at least 6 months to study the effect of CRF and hemodialysis on respiratory muscle function.
• group 2:
Thirty patients with chronic renal failure under conservative treatment to study the effect of CRF on respiratory muscle function were as a control group.
All patients were subjected to the following:
• Full history taking.
• Thorough clinical examination.
• Chest x-ray poster anterior view.
• Arterial blood gas analysis (for group 1 it was obtained one hour before and one hour after hemodialysis).
• Maximum inspiratory and expiratory pressures (PImax and PEmax) (for group 1 it was obtained one hour before and one hour after hemodialysis).
• Spirometry (for group 1 it was measured one hour before and one hour after hemodialysis).
• Serum electrolytes (Na+, K+, Ca++, Ph , Mg+, and Total proten ,Albumin).
Exclusion criteria:
• Ischemic heart disease (Recent M.I,unstable angina).
• Cardiac arrhythmias (Recent).
• Mental confusion.
• Neuromuscular diseases.
• Chronic liver disease.
• Associated pulmonary diseases as COPD and OHV$.
• Pregnant women.
• Patient refuses to sign the concent.
There was significant difference regarding PH, PCO2, PI MAX and MMEFR before and after dialysis (p≤0.05) in patients in group 1.
There was significant difference in PH, PCO2, PO2, PI MAX, FVC, FEV1%FVC and MMEFR between both groups.
There was significant ditect relationship between PH and PE MAX in group 2. (p=0.001).
There was significant direct relationship between PaO2 and MMEFR in group 2. (p=0.006).
There was significant direct relationship between PIMAX and FEV1in group 1 patients before dialysis (p=0.048).
There is significant direct relationship between PIMAX and MMEFR in group 1 patients before dialysis (p=0.005).
There was significant direct relationship between PEMAX and FVC in group 1 patients before dialysis (p=0.002).
There is significant direct relationship between PIMAX, and MMEFR in group 1 after dialysis. (p=0.001).