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sive medications. However, the quality of treatment may be inconsistent, leading to development of left ventricular hypertrophy and coronary artery disease. Not infrequently, dialysis patients are undergoing coronary artery bypass. This therapy is leading to increased survival and should not preclude a patient from being considered for renal transplantation.

Significant abnormal pulmonary function is unusual in patients with end-stage renal disease. However, alteration in pulmonary capillary permeability resulting in pulmonary edema at atrial pressures lower than in healthy persons has been described in uremic patients. Pulmonary edema and pleural effusions are more frequent also because of increased total body fluid. These and the additive problems caused by cigarette smoking may, in some cases, be significant. In general, dialysis patients have few symptoms related to the pulmonary system with the exception of occasional pulmonary edema.

There is a high frequency of bone and joint disease in dialysis patients. Hemo-dialysis patients generally have low calcium levels, high phosphorus concentrations, and elevated serum PTH levels. The degree of bone disease depends on the duration of renal failure and the diligence in which the bone disease is addressed.

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