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Key Clinical Message: Microscopic polyangiitis is a rare autoimmune vasculitis, that could present with renal‐pulmonary symptoms, posing diagnostic challenges in patients with preexisting kidney disease. Timely diagnosis is crucial to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Introduction: COVID-19, caused by SARS-CoV-2, has resulted in significant mortality and morbidity worldwide. Patients of chronic kidney disease who are on maintenance hemodialysis represent a vulnerable population cohort that is susceptible to severe disease. Hence, it is of utmost importance to prioritize vaccination in this population and to assess their response to said vaccination. Methods: This prospective analytical study was conducted at the Institute of Nephrology, Madras Medical College, between August 2021 and February 2022. Patients of chronic kidney disease stage 5 dialysis (CKD5D) who were on maintenance hemodialysis and who consented to receive COVID-19 vaccine were studied. Serum samples were obtained before vaccination, ≥28 days after receiving the first dose of the vaccine, and ≥28 days after receiving the second dose. Antibody titers against the spike protein were estimated using the Roche chemiluminescent immunosorbent assay. Patients were grouped into non-responders/seronegative (<0.8 U/ml) and responders/seropositive (≥0.8 U/ml), with a value ≥250 U/ml considered as robust response. Results: A total of 96 patients were included. The mean age was 36.70 (±11.53) years and 77.1% of them were male. The median dialysis vintage was 2 (IQR: 0.95-5) years. Twelve patients (9.9%) had a prior COVID-19 infection. Sixty-seven (69.8%) patients had received Covaxin and 29 (30.2%) had received Covishield vaccines. Among the 17 patients who were seronegative at baseline, 4 (23.52%) became seropositive after the first dose of the vaccine, and 11 (64.7%) were seropositive after the second dose, with high titers ("robust response") achieved in two patients (11.76%). No antibody response, despite two doses of the vaccine, was noted in six patients (35.29%). Conclusion: Our study showed a high baseline seropositivity rate, even prior to vaccination, which indicated a high rate of subclinical COVID infection. Among those who were seronegative at baseline, the seroconversion rate after two doses of Covaxin or Covishield was 64.70%. [ABSTRACT FROM AUTHOR]

Background: Epidemiologic studies on the effects of long-term exposure to ozone (O3) have shown inconclusive results. It is unclear whether to O3 has an effect on chronic kidney disease (CKD). We investigated the effects of O3 on mortality and renal outcome in CKD. Methods: We included 61,073 participants and applied Cox proportional hazards models to examine the effects of ozone on the risk of end-stage renal disease (ESRD) and mortality in a two-pollutants model adjusted for socioeconomic status. We calculated the concentration of ozone exposure one year before enrollment and used inverse distance weighting (IDW) for interpolation, where the exposure was evenly distributed. Results: In the single pollutant model, O3 was significantly associated with an increased risk of ESRD and all-cause mortality. Based on the O3 concentration from IDW interpolation, this moving O3 average was significantly associated with an increased risk of ESRD and all-cause mortality. In a two-pollutants model, even after we adjusted for other measured pollutants, nitrogen dioxide did not attenuate the result for O3. The hazard ratio (HR) value for the district-level assessment is 1.025 with a 95% confidence interval (CI) of 1.014–1.035, while for the point-level assessment, the HR value is 1.04 with a 95% CI of 1.035–1.045. The impact of ozone on ESRD, hazard ratio (HR) values are, 1.049(95%CI: 1.044–1.054) at the district unit and 1.04 (95%CI: 1.031–1.05) at the individual address of the exposure assessment. The ozone hazard ratio for all-cause mortality was 1.012 (95% confidence interval: 1.008–1.017) for administrative districts and 1.04 (95% confidence interval: 1.031–1.05) for individual addresses. Conclusions: This study suggests that long-term ambient O3 increases the risk of ESRD and mortality in CKD. The strategy to decrease O3 emissions will substantially benefit health and the environment. [ABSTRACT FROM AUTHOR]

Background/Aims: The aim of this study is to investigate the utility of clinical [age, gender, mean arterial pressure (MAP)] and laboratory parameters [eGFR, hemoglobin (Hgb), serum levels of creatinine, uric acid, albumin, proteinuria, hematuria] and also histopathological lesions (Oxford classification parameters, crescents, intensity and pattern of staining for C3, C1Q, IgA, IgG, IgM) as progression markers in patients with IgA Nephropathy (IgAN). Methods: A total of 111 IgAN patients with a follow-up period >1 year or who reached kidney failure [GFR category G5 chronic kidney disease (CKD)] <1 year were investigated. Primary endpoint was the development of kidney failure or eGFR decline ≥50% from the baseline. Kaplan-Meier and Cox proportional hazards analyses were performed. Results: Mean follow-up period was 33±29 months. Thirty-seven (33.3%) patients progressed to kidney failure and 4 (3.6%) patients developed eGFR decline ≥50% from the baseline after a median of 23 and 65 months, respectively. In multivariate Cox regression analysis, baseline levels of Hgb (HR:0.782, 95% CI 0.559-0.973, p=0.037), serum uric acid (HR:1.293, 95% CI 1.023-1.621, p=0.046), eGFR (HR:0.966, 95% CI 0.947-0.984, p=0.004) and intensity of C3 staining (HR:1.550, 95% CI 1.198-1.976, p=0.049) predicted primary endpoint. Serum uric acid level was associated independently with T score (β=0.303, p=0.005) in patients with eGFR>30 ml/min/m2. Conclusions: Hyperuricemia and the deposition of C3 are independent risk factors for IgAN progression. [ABSTRACT FROM AUTHOR]

Background: Patients with end stage renal disease (ESRD) are at a higher risk of developing tuberculosis (TB) due to the immunosuppressed state along with concomitant comorbidities and socioeconomic and demographic factors. Data on the prevalence of tuberculosis in ESRD are scarce despite the high burden of the disease in developing nations. Methods: A multicenter, cross-sectional study was conducted at eight dialysis centers in Addis Ababa on the prevalence of TB among CKD patients on maintenance hemodialysis from August 2022 to October 2022 G.C. The study enrolled 263 participants selected by systematic random sampling. Data were collected by reviewing the patient's electronic medical records. The Collected data were analyzed using SPSS version 26.0. Results: Our study found a 27% prevalence of TB in patients with ESRD receiving maintenance hemodialysis (MHD). Pulmonary tuberculosis was the most prevalent form, and lymphadenitis was the most common extra-pulmonary tuberculosis (EPTB). Only 5.6% of the study participants had microbiologic evidence of TB. Chemistry and cytological studies from pleural fluid and imaging evidences were commonly used diagnostic modalities. The presence of HIV infection, longer duration of dialysis (> 1 year), and contact history with a known TB patient were all significantly associated with higher prevalence of TB among the study participants. Conclusion: Although there is a strong association between TB and CKD, there are no local data from Ethiopia. Our study identified a higher prevalence of TB among CKD patients on MHD. Thus, maintaining a high index of suspicion and early diagnosis and treatment of TB among ESRD patients on MHD and use of TB preventive therapy (TPT) is important in decreasing morbidity and mortality. [ABSTRACT FROM AUTHOR]

Introduction: Ocular manifestations of Haemodialysis (HD) are one of the important causes of morbidity in End-stage Renal Disease (ESRD) patients. According to studies, the incidence rate of glaucoma in the dialysis group was higher than that in the non dialysis group. Angle-closure glaucoma was found to be more common, which depends on anterior chamber morphology. Aim: To assess the effect of HD on Intraocular Pressure (IOP), Anterior Chamber Depth (ACD), and Lens Thickness (LT) in patients with ESRD. Materials and Methods: This was a single-centre crosssectional observational study conducted in the Department of Ophthalmology on 170 eyes of 87 patients undergoing HD for at least three months. The study was conducted between October 2020 and October 2022 at the Dialysis Centre of Bharati Vidyapeeth (DTU) Medical College and Hospital, Pune, Maharashtra, India. These patients underwent ophthalmological evaluation pre- and postdialysis. IOP, ACD, and LT were measured 30 minutes prior to and 30 minutes after the HD session. The paired t-test was used to compare differences in means, and a p-value of <0.05 was considered significant. Results: The mean age of the study participants was 57.63±11.95 years. There was a decrease in mean ACD by 0.08±0.29 mm (p=0.0001) and an increase in mean LT by 0.06±0.42 mm (p-value=0.0001) postdialysis. The changes in IOP were variable and not statistically significant (p=0.45). Conclusion: Postdialysis, a significant increase in LT was observed corresponding to a decrease in ACD. Although the change in IOP was variable, this change might be more significant in pre-existing narrow-angle patients undergoing dialysis. As a result, the present study underscores the urgency of refining screening protocols for HD patients to effectively address these identified ocular changes and associated risks. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis (OS) and fractures are common in patients with end-stage renal disease (ESRD) and maintenance dialysis patients. However, diagnosing osteoporosis in this population is challenging. The aim of this research is to explore the common genetic profile and potential molecular mechanisms of ESRD and OS. Methods and results: Download microarray data for ESRD and OS from the Gene Expression Omnibus (GEO) database. Weighted correlation network analysis (WGCNA) was used to identify co-expression modules associated with ESRD and OS. Random Forest (RF) and Lasso Regression were performed to identify candidate genes, and consensus clustering for hierarchical analysis. In addition, miRNAs shared in ESRD and OS were identified by differential analysis and their target genes were predicted by Tragetscan. Finally, we constructed a common miRNAs-mRNAs network with candidate genes and shared miRNAs. By WGCNA, two important modules of ESRD and one important module of OS were identified, and the functions of three major clusters were identified, including ribosome, RAS pathway, and MAPK pathway. Eight gene signatures obtained by using RF and Lasso machine learning methods with area under curve (AUC) values greater than 0.7 in ESRD and in OS confirmed their diagnostic performance. Consensus clustering successfully stratified ESRD patients, and C1 patients with more severe ESRD phenotype and OS phenotype were defined as “OS-prone group”. Conclusion: Our work identifies biological processes and underlying mechanisms shared by ESRD and OS, and identifies new candidate genes that can be used as biomarkers or potential therapeutic targets, revealing molecular alterations in susceptibility to OS in ESRD patients. [ABSTRACT FROM AUTHOR]

Recent data, indicating that inflammatory bowel disease (IBD) may be a risk factor for future chronic kidney disease, highlight the need to study the safety and clinical effectiveness of advanced IBD therapies in patients with end stage renal disease (ESRD), defined as an eGFR <15 mL/min/1.73m2. Upadacitinib, a selective oral Janus kinase (JAK) 1 inhibitor, has demonstrated efficacy in the management of moderate to severe ulcerative colitis. There is also emerging data indicating that JAK inhibition may be clinically effective in the setting of steroid‐refractory acute severe ulcerative colitis (ASUC). There is, however, a lack of "real‐world" data documenting the use of JAK inhibitors in patients with ESRD. Here, we report the use of upadacitinib in a patient with ESRD for the management of steroid‐refractory ASUC, demonstrating, for the first time, the safe and clinically effective use of upadacitinib in this population. [ABSTRACT FROM AUTHOR]

Introduction: Chronic kidney disease is a widespread medical problem that leads to higher morbidity, mortality, and a decrease in the overall well-being of the general population. This is especially expressed in patients with end-stage renal disease (ESRD) undergoing maintenance haemodialysis. Several variables could be used to evaluate those patients' well-being and mortality risk. One of them is the presence of residual urine output.Materials and Methods: The study was conducted on 485 patients treated with maintenance haemodialysis. After enrollment in the study, which consisted of medical history, physical examination, hydration assessment, and blood sampling, each patient was followed up for 24 months. We used residual urine output (RUO) as a measure of residual renal function (RRF). The entire cohort was divided into 4 subgroups based on the daily urinary output (<=100mL per day, > 100mL to <=500mL, > 500mL to <=1000mL and > 1000mL).Results: The data show that the mortality rate was significantly higher in groups with lower RUO, which was caused mainly by cardiovascular events. Also, patients with higher RUO achieved better sodium, potassium, calcium, and phosphate balance. They were also less prone to overhydration and had a better nutritional status. Preserved RRF also had a positive impact on markers of cardiovascular damage, such as NT-proBNP as well as TnT.Conclusion: In conclusion, preserving residual urine output in ESRD patients undergoing maintenance haemodialysis is invaluable in reducing their morbidity and mortality rates and enhancing other favourable parameters of those patients. [ABSTRACT FROM AUTHOR]

Reliable models of renal failure in large animals are critical to the successful translation of the next generation of renal replacement therapies (RRT) into humans. While models exist for the induction of renal failure, none are optimized for the implantation of devices to the retroperitoneal vasculature. We successfully piloted an embolization-to-implantation protocol enabling the first implant of a silicon nanopore membrane hemodialyzer (SNMHD) in a swine renal failure model. Renal arterial embolization is a non-invasive approach to near-total nephrectomy that preserves retroperitoneal anatomy for device implants. Silicon nanopore membranes (SNM) are efficient blood-compatible membranes that enable novel approaches to RRT. Yucatan minipigs underwent staged bilateral renal arterial embolization to induce renal failure, managed by intermittent hemodialysis. A small-scale arteriovenous SNMHD prototype was implanted into the retroperitoneum. Dialysate catheters were tunneled externally for connection to a dialysate recirculation pump. SNMHD clearance was determined by intermittent sampling of recirculating dialysate. Creatinine and urea clearance through the SNMHD were 76–105 mL/min/m2 and 140–165 mL/min/m2, respectively, without albumin leakage. Normalized creatinine and urea clearance measured in the SNMHD may translate to a fully implantable clinical-scale device. This pilot study establishes a path toward therapeutic testing of the clinical-scale SNMHD and other implantable RRT devices. [ABSTRACT FROM AUTHOR]

Background: Autogenous Arterivenous (AV) access is the preferred choice for hemodialysis access in chronic kidney patients. Cimino fistulas are currently accepted as the best mode of vascular access for hemodialysis. The present study was planned to look for the presence of on table bruit and thrill and to know the postoperative outcome and patency. Material and Methods: This single center, prospective study was done in the department of vascular surgery at SMC, from January 2020 - January-2021. Dominance of hand was noted, and preference was given to non- dominant hand. Physical examination of the arterial system along with venous system was done. Preoperative color Doppler of upper limb veins and arteries was done in all the patients. Results: In study of 291 AV access, there were 161(55.3%) AV access which were successfully used for hemodialysis and 83(28.5%) were not. Arterial diameters was significantly found to be higher in those patients with patent AVFs. Conclusion: Creating and maintaining an autogenous AV access for hemodialysis is a complex process subject to patient specific characteristics and surgical expertise. This study suggests that patency rates and functional outcomes of dialysis access procedures are better in patients who are non-smokers, without comorbidities, without previous H/O AVF failure. [ABSTRACT FROM AUTHOR]

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A novel simple optical sensor based on fast protein liquid chromatography was developed and tested for monitoring end stage renal disease (ESRD) patients treated with continuous ambulatory peritoneal dialysis (CAPD). The device provides direct determination of proteins and lower molecular weight metabolites in effluent peritoneal dialysate using ultraviolet (UV) photometric detection at the wavelengths 285 nm or 260 nm with deep ultraviolet light-emitting diodes. The sensor was calibrated with bovine serum albumin and nucleotides standard solutions. Chromatograms of peritoneal dialysate samples taken from a group of 28 ESRD patients were processed and approximated by a set of split-Gaussian functions. All chromatograms show three overlapping peaks: the first one represents proteins; the other two peaks probably correspond to mid- and low molecular weight metabolites. Strong correlation was reveled between the area of the first peak and total protein concentration determined by a standard biochemical assay, this makes possible estimation of peritoneal protein loss with a reasonable precision less than 15%. The area of the second peak correlated with dialysate optical density at a wavelength 355–365 nm, associated with the UV absorption of advanced glycation end (AGE) products. The third peak correlated with the optical density of the eluate at a wavelength 255–265 nm, associated with the UV absorption of purines and pyrimidines. Thus, we demonstrated the possibility of estimation of proteins and lower molecular weight metabolites in effluent peritoneal dialysate with the compact and affordable chromatographic optical sensor. [ABSTRACT FROM AUTHOR]

Aims: Heart failure (HF) is one of the leading causes of cardiovascular morbidity and mortality. HF with preserved ejection fraction (HFpEF), or diastolic failure, accounts for half of all HF cases and differs from HF with reduced ejection fraction (HFrEF). Patients with HFpEF are typically older, female, and commonly seen with chronic kidney disease (CKD), one of the leading independent risk factors for mortality in these patients. Unfortunately, drugs that had shown significant improvements in mortality in HFrEF have not shown similar benefits in HFpEF. Recently, sodium glucose transporter 2 inhibitors (SGLT2i) have been shown to reduce cardiovascular morbidity and mortality in HFrEF patients and slow down CKD progression. This study aimed to elucidate the impact of this drug class on mortality and risk of end stage renal disease in patients with HFpEF, which is currently unclear. Methods and results: We retrospectively analysed the Research Data Warehouse containing electronic health records from de‐identified patients (n = 1 266 290) from the University of Mississippi Medical Center from 2013 to 2022. HFpEF patients had an average follow‐up of 4 ± 2 years. Factors associated with increased all‐cause mortality during HFpEF included age, male sex, and CKD. Interestingly, the only treatments associated with significant improvements in survival were angiotensin converting enzyme inhibitors/angiotensin receptor blockers and SGLT2i, regardless of CKD or diabetes status. Additionally, SGLT2i use was also associated with significant decrease in the risk of end stage renal disease. Conclusions: Our results support the use of SGLT2i in an HFpEF population with relatively high rates of hypertension, CKD, and black race and suggests that improvements in mortality may be through preserving kidney function. [ABSTRACT FROM AUTHOR]

Background and aim: Immunoglobulin A nephropathy (IgAN) is the most common primary glomerulonephritis worldwide. We aimed to evaluate whether obesity is a risk factor for IgAN patients. Methods: A total of 1054 biopsy-proven IgAN patients were analyzed in this retrospective study. Patients were divided into four groups according to their body weight index (BMI) at the period of renal biopsy: underweight group (BMI< 18.5, N=75), normal weight group (18.5=BMI<24, N=587), overweight group (24=BMI<28, N=291) and obesity group (28=BMI, N=101). The endpoint of our study was end stage renal disease (ESRD: eGFR <15 mL/min/1.73 m2 or having renal replacement treatment). Kaplan-Meier analyses and Cox proportional hazard models were performed to evaluate renal survival. Propensity-score matching (PSM) was performed to get the matched cohort to evaluate the role of obesity in IgAN patients. Besides, the effect modification of obesity and hypertension in IgAN patients was clarified by the synergy index. Results: IgAN patients complicated with obesity had more severe renal dysfunction at the time of renal biopsy than those with optimal body weight. In addition, patients with obesity tended to have higher risk of metabolic disorders, such as hyperuricemia (64.4% vs 37%, p<0.001), hypertriglyceridemia (71.3% vs 32.5%, p<0.001) and hypercholesterolemia (46.5% vs 35.6%, p=0.036). It was observed that obesity patients had higher rate of unhealthy behaviors, such as smoking (27.7% vs 16.4%, p=0.006) and alcohol drinking (29.7% vs 19.9%, p=0.027). Although obesity was not confirmed as an independent risk factor for IgAN patients, we found that IgAN patients with obesity presented with higher incidence of hypertension, as well as lower event-free renal survival rate (logrank p < 0.001), especially in patients with 24-h urine protein = 1g (log-rank p =0.002). In addition, the synergy index showed that there was positive interaction between obesity and hypertension in IgAN. Conclusion: Obesity is an important risk factor for IgAN patients when combined with hypertension. Hypertension appears to be common in obese IgAN patients. [ABSTRACT FROM AUTHOR]

Copyright of Namık Kemal Tıp Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Fabry disease is an X-linked lysosomal storage disease, second in prevalence after Gaucher disease. The onset of symptoms occurs in childhood or adolescence with palmo-plantar burning pains, hypo hidrosis, angiokeratomas, and corneal deposits. In the absence of diagnosis and treatment, the disease will progress to the late phase, characterized by progressive cardiac, cerebral and renal damage, and possible death. We present the case of an 11-year-old male boy who was transferred to the Pediatric Nephrology Department for palmo-plantar burning pain and end stage renal disease. Following the evaluations for the etiology of end stage renal disease we excluded the vasculitis, the neurologic diseases, extrapulmonary tuberculosis. Because of suggestive aspect at CT scan and lack of etiologic diagnosis of renal insufficiency we performed lymph node and kidney biopsy, with a surprising result for storage disease. The specific investigation confirmed the diagnosis. [ABSTRACT FROM AUTHOR]

Background and Aim: This study aims to evaluate the clinical and histopathological profile in children with crescentic glomerulonephritis (CGN) and determine the predictors of renal outcome. Methods: In this retrospective study, we reviewed all native kidney biopsies performed in patients <18 years over 9 years (2011-2019). Individuals with ≥20% crescents with follow-up for at least 1 year were enrolled. Results: This study included 34 patients. The most common variety was immune-complex glomerulonephritis (GN) (type II CGN) (n=21; 62%), including patients with Henoch- Schonlein purpura (n=6), lupus nephritis (n=6), post-infectious GN (n=3), C3GN (n=3), and dense deposit disease (n=3). The second most common was pauci-immune GN (type III CGN; n=12; 35%) followed by anti-glomerular basement membrane disease (type I CGN; n=1; 3%). Hypertension (88%), hematuria (84.2%), and oliguria (64%) were the most common presenting features. The outcome predictors for poor renal survival were the presence of oliguria (HR-5.11, P=0.035), severe hypertension (HR-11.51, P=0.019), estimated glomerular filtration rate <15 mL/min/1.73 m2 at presentation (HR-5.05, P=0.007), percentage of crescents (HR-10.66, P=0.001), presence of fibrous crescents (HR-6.34, P=0.001), and interstitial fibrosis and tubular atrophy (HR-8.88, P=0.0046). The overall outcome of the study revealed complete recovery (n=12), partial recovery (n=6), chronic kidney disease (n=3), and end-stage renal disease (n=13). The renal survival in patients with ≥50% crescents was poor (P=0.037) as compared to subjects with <50% crescents. Conclusion: Renal survival can be predicted by the severity of presenting features and histopathological markers. Two-thirds of patients had type II CGN with renal survival outcomes similar to type III CGN. The percentage of crescents is the most important predictor of renal survival. [ABSTRACT FROM AUTHOR]

Objective: Continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) are main modalities for end stage renal disease (ESRD) patients, and those have been covered by National Health Insurance (NHI) scheme since 2014 in Indonesia. This study aims to update the cost-effectiveness model of CAPD versus HD in Indonesia setting. Results: Compared to HD, CAPD provides good value for money among ESRD patients in Indonesia. Using societal perspective, the total costs were IDR 1,348,612,118 (USD 95,504) and IDR 1,368,447,750 (USD 96,908), for CAPD and HD, respectively. The QALY was slightly different between two modalities, 4.79 for CAPD versus 4.22 for HD. The incremental cost-effectiveness ratio (ICER) yields savings of IDR 34,723,527/QALY (USD 2460). [ABSTRACT FROM AUTHOR]

Background: RDW is critical to the clinical diagnosis and progression of ESRD. There is currently little data on the relationship between RDW and ESRD in sub-Saharan Africa. Because of this, the present study evaluates RDW in patients with ESRD and associated factors in Addis Ababa, Ethiopia. Methods: The hospital-based cross-sectional study design was conducted on a total of 83 patients. RDW, MCV, SCR, BUN, GFR, FBS and serum albumin were determined. Blood pressure (mmHg), weight (kg), height (m), MUAC (cm) and BMI (kg/m2) were also measured. Data entry was via Epi-data version 3.4 and analyzed with SPSS version 26.0. A multivariate logistic regression analysis with a p-value < 0.05 at a 95% confidence interval was used to identify the associated factors of RDW. Results: A total of 83 ESRD patients participated, with a response rate of 95.4%. RDW ranged from 15.5% to 23.6% with a mean of 17.40% + 1.46%. Anisocytosis was present in 98.8% of patients. Of 83 patients, 66.3% were hypertensive, 20.5% had diabetes, and the remaining 13.3% had other conditions (glomerulonephritis and peripheral vascular disease). The mean GFR value was 5.20 mL/min/1.73 + 1.58. RDW showed a significant association with GFR (AOR: 4.6, 95% CI [1.27, 20.74], P = 0.047), alcohol consumption (AOR: 13.4, P = 0.012, 95% CI [1.97, 22.62]), recurrent kidney disease (AOR=25.6, P=0.016, 95% CI [1.85, 53.71]) and use of medication (AOR=00.2, P=0.044), 95% CI [0.03, 0.95]). Conclusion: RDW showed a significant association with GFR, recurrent kidney disease, alcohol consumption, and medication use in hemodialysis-dependent ESRD patients. The mechanisms of RDW disruption in ESRD patients need further investigation. [ABSTRACT FROM AUTHOR]

Background: Inadequate health literacy (HL) in dialysis patients increases the risk of poor self-care and decreases severe self-care and severe negative health outcomes in these patients. This study aimed to investigate HL and its related factors in dialysis patients in Kerman, Iran, in 2021. Methods: This cross-sectional study was performed on 280 dialysis patients who referred to Kerman (Iran) dialysis centres. The participants were selected through multi-stage sampling method. The study was conducted using the Iranian Health Literacy Questionnaire (IHLQ). The higher score shows a better HL. Results: The mean age of the subjects was 57.75±13.87 years. The mean score of HL was 9.12±4.54 out of 20 points. During multivariate regression, there was a significant relationship between HL and age (β=-0.08, P=0.02) and level of education (elementary/ literacy (β=4.607, P<0.001), middle school (β=6.38, P<0.001), high school (β=8.573, P<0.001) and academic education (β=9.410, P<0.001), and there was a significant relationship between HL and eye disease (β=-0.903, P=0.001). Conclusion: Most participants did not have adequate HL, while HL as the most important determinant of self-care can improve patients’ quality of life and reduce their health care costs. Therefore, in order to increase self-care, planning and necessary interventions, the HL of these patients seems to be necessary. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess the presence of elbow pain and its relationship with vascular access site for hemodialysis in end-stage renal disease patients. Methods: One-hundred and nine chronic end-stage renal disease patients over 18 years of age undergoing hemodialysis treatment were enrolled in the study. Patients who had undergone surgery of the upper extremity in the last three months and patients with cancer, chronic hearing loss, or neurologic diseases were excluded. Sociodemographic features were evaluated. The Beck Depression Inventory, the Nottingham Health Profile, the Disabilities of the Arm, Shoulder and Hand Score, and the Visual Analogue Scale were administered to all patients. Results: One-hundred and nine patients (38 women, 71 men) participated in the study. The mean age of the patients was 62.22 ± 11.64. The patients were grouped based on the presence of elbow pain into Group 1 (elbow pain positive, n=30) and Group 2 (elbow pain negative, n=79). There was a statistically significant difference between the groups in terms of vascular access site and elbow pain site (p=0.002). In addition, the patients with elbow pain were mostly women, and this result was statistically significant (p<0.05). Conclusions: According to the results of this study, there may be a relationship between elbow pain and hemodialysis vascular site. [ABSTRACT FROM AUTHOR]

Background: Adherence of patients with End-Stage Renal Disease (ESRD) to Hemodialysis (HD), prescribed medications, diet and fluid restrictions is essential to get the desirable outcome and prevent complications. During COVID-19 pandemic, ESRD patients became more concerned with attending the HD sessions and following the protective measures because of the potential for increased susceptibility to COVID-19. The aim of this study was to evaluate the impact of the pandemic on patients' adherence to HD and medical regimens.Methods: Two hundred five ESRD patients on HD were interviewed with the ESRD Adherence Questionnaire (ESRD-AQ) and the Fear-of-COVID-19 Scale (FCV-19S). Clinical and laboratory correlates of adherence were retrieved from patients' records.Results: Self-reported adherence to HD showed that 19.5% were not adherent to HD during the pandemic compared to 11.7% before the pandemic (p < 0.001), with a significant agreement with the actual attendance of HD sessions (Kappa = 0.733, p < 0.001). Twenty-five patients (12.2%) had a history of COVID-19. The FCV-19S had a mean score of 18.8 and showed significant positive correlations with the pre-dialysis phosphorus and potassium. Multivariate analysis showed that the main predictors of non-adherence were the history of COVID-19, understanding and perception scores, and the Fear-of-COVID score.Conclusions: The COVID-19 pandemic adversely affected the adherence of ESRD patients to HD and medical regimen. Strategies to mitigate patients' fears of COVID-19 and improve their understanding and perceptions of adherence to HD and medical regimen should be adopted in HD centers during the pandemic. [ABSTRACT FROM AUTHOR]

The gut microbiota has nutritional and protective functions. In patients with end-stage renal disease, changes in the gut microbiota disrupt their protective functions. Probiotics help maintain normal bowel function. However, their role in patients with end-stage renal disease is controversial. We investigated whether Clostridium butyricum affects the nutrition and immune function of patients with end-stage renal disease undergoing maintenance dialysis between 2014 and 2015; thirty-seven patients were included. The patients were divided into two groups: one in which C. butyricum was administered and one in which it was not. One tablet of the probiotics, which contained 20 mg of C. butyricum, was administered orally three times daily for 2 years in the C. butyricum group. The 16S rRNA genes were sequenced from stool samples of 14 (37.8%) patients in the C. butyricum group and 23 (62.2%) patients in the control group. The differences in the gut microbiota of the two groups were analyzed. The α-diversity index indicated that the C. butyricum group had significantly more operational taxonomic units and higher albumin and transferrin levels than the control group. The effector to target cell ratio was significantly higher in the C. butyricum group. In addition, interleukin-6 levels were significantly lower in the C. butyricum group, and inflammation was less severe in this group. The patients undergoing maintenance dialysis with C. butyricum had abundant gut microbiota. They also had a good nutritional status, low systemic inflammation, and a good immunological status. [ABSTRACT FROM AUTHOR]

Background: We evaluated restenosis rates at the cephalic arch after percutaneous angioplasty and stenting procedures in patients with brachial artery to cephalic vein arteriovenous fistula (BCAVF) hemodialysis access.Methods: We used data from adult hemodialysis patients treated at a national network of 44 outpatient interventional facilities during Oct 2011-2015. We included data from patients with BCAVF who received an exclusive angioplasty, or stent with angioplasty, for treatment of cephalic arch stenosis and had ≥1 subsequent evaluation of the cephalic arch. Median percent restenosis per month at cephalic arch and days between encounters was calculated from the 1st index to 2nd procedure, and for up to 4 subsequent encounters. Analyses were stratified by intervention and device types.Results: We identified a cohort of 3301 patients (mean age 62.2 ± 13.9 years, 58.5% male, 33.2% white race) with a BCAVF who had an angioplasty, or stent, at the cephalic arch for an index and ≥ 1 follow-up procedure. Between the 1st index to 2nd procedure, patients who received an angioplasty (n = 2663) or stent (n = 933) showed a median decrease of 18.9 and 16.5% in luminal diameter per month and a median time of 93 and 91 days between encounters, respectively. Restenosis and day rates were similar for standard versus high-pressure angioplasties. Bare metal stents showed 10.1 percentage point higher restenosis rate compared to stent grafts. Restenosis rates and time to restenosis were relatively consistent across subsequent encounters.Conclusions: Findings suggest hemodialysis patients with a BCAVF who require an angioplasty or stent to treat a stenosis at the cephalic arch will have stenosis reformed at a rate of 18.9 and 16.5% per month after the first intervention, respectively. Findings suggest patients are at risk of having significant lesions at the cephalic arch within 3 months after the previous intervention. [ABSTRACT FROM AUTHOR]

Background / Aim: Nephrotic syndrome (NS) is a clinical syndrome characterised by massive proteinuria > 3.5 g in 24 h urine, hypoalbuminaemia, hyperlipidaemia and oedema. Aim of this study was to determine the aetiology and frequency of kidney diseases that occur as the cause of NS in adults in the Republic of Srpska and the progression of renal insufficiency, disease outcomes and efficacy of applied therapy. Methods: The retrospective study included patients aged 18 to 80 hospitalised between 2014 and 2018 due to clinically and laboratory-manifested NS. In patients with suspected primary glomerular disease, a kidney biopsy with immunofluorescent dyeing was performed. The first examination involved hospital admission and the next check-up six months after the first hospitalisation. Basic clinical parameters were followed: creatinine, clearance creatinine, albumin, total protein, cholesterol, total protein in 24 h urine and microscopy of urine during the first hospitalisation and repeated same laboratory findings on control. The progression of kidney failure during this period was assessed, as well as the efficacy of immunosuppressive therapy. Results: In primary NS category membranous glomerulonephritis (MGN) was present at 40.7 % of patients, followed by focal segmental glomerulosclerosis (FSGS) 21.7 %, membranoproliferative glomerulonephritis (MPGN) 11.9 % and IgA glomerulonephritis (IgAN) 11.9 %. Nephroangiosclerosis was verified as the most common cause of secondary NS with 28.8 % and lupus nephritis 21.2 %, followed by ANCA-associated GN (11.5 %) and diabetic nephropathy (11.5 %). Thirty-four patients (21 %) died during the follow-up. Thirty-four patients (18.6 %) progressed to end stage renal disease during the five-year follow-up. Conclusion: The pathology of kidney disease in older patients is often very complex; therefore, a kidney biopsy should be conducted at an early stage of kidney disease for the purpose of obtaining an accurate diagnosis, determining appropriate treatment and thus improving the prognosis of the patient. [ABSTRACT FROM AUTHOR]

Introduction: Chronic kidney disease is defined as structural or functional damage of the kidney persisting for three or more months. Studies have shown hypertension and diabetes as the leading causes of chronic kidney disease. The aim of this study is to find out the prevalence of end-stage renal disease patients undergoing haemodialysis in a tertiary care hospital. Methods: This was a descriptive cross-sectional study conducted among 96 patients undergoing haemodialysis from February 13, 2021 to April 4, 2021 in the hemodialysis unit of a tertiary care centre after receiving ethical clearance from the Institutional Review Committee (Reference number: 354). Convenience sampling was done and all patients older than 18 years who were on maintenance haemodialysis on an outpatient basis were included in the study. Data were collected using a self-administered questionnaire. Data were analysed using the Statistical Package for the Social Science version 22.0. Point estimate at 95% Confidence Interval was calculated along with frequency and percentages for binary data and mean with standard deviation for continuous data. Results: Among 96 patients undergoing haemodialysis, the prevalence of end-stage renal disease was 83 (86.45%) (79.60-93.30 at 95% Confidence Interval). The most common underlying condition was hypertensive nephropathy in 34 (40.96%) patients, followed by both hypertensive and diabetic nephropathy in 26 (31.33%) patients. Conclusions: The prevalence of end-stage renal disease in our study was higher when compared to similar studies conducted in similar settings. Early diagnosis and adequate treatment of hypertension and diabetes could be crucial to reducing the prevalence of the end-stage renal disease.

Introduction: The effect of age on health outcomes in kidney transplantation remains inconclusive. This study aimed to analyze the relationship between age at time of kidney transplantation with mortality, graft loss and self-rated health status in adult kidney transplant recipients. Methods: This study used data from the Swiss Transplant Cohort Study and included prospective data of kidney transplant recipients between 2008 and 2017. Time-to-event analysis was performed using Cox’ regression analysis, and -in the case of graft loss- competing risk analysis. A random-intercept regression model was applied to analyse self-rated health status. Results: We included 2,366 kidney transplant recipients. Age at transplantation linearly predicted mortality. It was also predictive for graft loss, though nonlinearly, showing that recipients aged between 35 and 55 years presented with the lowest risk of experiencing graft loss. No relationship of age with self-rated health status was detected. Conclusion: Higher mortality in older recipients complies with data from the general population. The non-linear relationship between age and graft loss and the higher scored self-rated health status at all follow-up time-points compared to the pre-transplant status -regardless of age- highlight that age alone might not be an accurate measure for risk prediction and clinical decision making in kidney transplantation. [ABSTRACT FROM AUTHOR]

Background: All patients with chronic renal failure need vascular access for hemodialysis that is possible with CVP line but it shorter life. The most suitable and effective vascular access on long term basis is the creation of arteriovenous fistula (AVF). The objective of this study was to compare the patency rate of Radiocephalic vs. Brachiocephalic AVFs in population of D.I.Khan division, Pakistan. Materials & Methods: This randomized control trail was conducted in Department of Surgery Gomal Medical College, D.I.Khan, Pakistan from January 2017 to December 2019. 266 patients were equally randomly allocated into Brachiocephalic AVF (BCAVF) and Radiocephalic AVF (RCAVF). Sex, age groups and patency of AVT were nominal variables. Data for sample was described by count & percentages and for population as confidence interval at 80% confidence level. McNemar chi-square test was used to test hypothesis to compare patency rate of Brachiocephalic AVF vs. Radiocephalic AVF. Results: Patency was present in 129 (97%, 80% CI 94.45-98.39%) and absent in four (3%, 80% CI 1.61-5.55%) cases in Brachiocephalic, while it was present in 107 (80.5%, 80% CI 76.04-84.86%) cases and absent in 26 (19.5%, 80% CI 15.52-24.32%) cases in Radiocephalic AVF group. McNemar chi-square test showed p <.0001, so the null hypothesis was rejected, showing higher patency rate in BCAVF. Conclusion: Brachiocephalic AVF creation is more ideal in terms of patency and maturation as compare to Radiocephalic AVF because of increased vessel diameter and increased arterial pressure at proximal site below elbow joint. [ABSTRACT FROM AUTHOR]

Objectives: Assessment of health related quality of life (HRQOL) is an essential part of evaluation of end stage renal disease (ESRD) as we have conducted this study on haemodialysis patients to see the HRQOL and to asses and compare the parameters which influence physical and mental health. Materials and Methods: This was a single centre study on haemodialysis patients using Short Form 36 (SF-36) of Kidney Disease Quality of Life (KDQOL). All the eight domains of HRQOL were assessed individually as well as summary scores for mental health (MCS Mental composite summary) and physical health (PCS Physical composite summary) were also evaluated. The questionnaire was completed by patient themselves and the clinical data was extracted from the medical records with prior consent from the patient. Results and discussion: The study participants showed a female predominance of 66% with a lower PCS and MCS scores among female participants in comparison to their male counterparts. Overall summary scores showed a lower PCS (38.71±8.15) than MCS (42.79±11.6) which reflects better mental health than physical health in the study population. A multiple regression analysis showed, the presence of residual renal function (ß= -0.421, p= 0.02), duration of dialysis (ß= 0.405, p= 0.03) and haemoglobin less than 12g/dL (ß= 0.379, p= 0.02) were significant predictors of MCS. Conclusion: HRQOL in haemodialysis patients are influenced by socio-demographic as well as clinical parameters. In our population, kidney disease affects physical health more than mental health and the reasons are multifactorial. [ABSTRACT FROM AUTHOR]

Hemodialysis affects the socio-economic status of patients with end stage renal disease (ESRD) resulting in a large number of psychological disorders for both the patients and their families. The purpose of this study is to explore the experiences of patients undergoing dialysis at Greater Regional Hospital in Ghana. The researchers employed a qualitative phenomenological research design using and analyzed using Interpretive Phenomenological Analysis. A purposive sampling technique was employed by the researchers to select 16 participants who were engaged in face-to-face in-depth interviews conducted. The socio-demographic characteristics revealed that majority were males (n = 11; 69%)and more than half of the participants (n = 14; 87.5%), were over 40 years. Again, most of the participants indicated spending between 150USD to 180USD weekly on dialysis treatment alone. The study revealed 3 themes and 13 subthemes emerged from the analysis of this data. The main themes were the Physical experiences of patients prior to starting dialysis, personal experiences during dialysis and socioeconomic burden on the participants. Participants faced challenges prior to and whilst on dialysis however the symptoms were better whilst on dialysis. It is therefore recommended that participants with ESRD are supported to go through dialysis treatment to enhance their quality of life. [ABSTRACT FROM AUTHOR]

Introduction. Kidney transplantation is the treatment of choice in the majority of end-stage renal disease (ESRD) patients. However, most of the incident ESRD patients are not given the necessary information regarding kidney transplantation. The aim of this study was to evaluate awareness and knowledge about kidney transplantation in ESRD patients who were on dialysis. Methods. In this cross-sectional study, a total of 300 ESRD patients who underwent hemodialysis or peritoneal dialysis and could be eligible for kidney transplant, were included. A questionnaire with 15 multiple choice questions (MCQs) was designed to collect the data. SPSS version 16 was used for data analysis and a P value less than .05 was considered statistically significant. Results. Two hundred thirty-four patients participated in the study (response rate of 78%). Among them 58.1% were male with the mean age (SD) of 52.5 (12.1) years. The majority of the patients (94.0%) were on hemodialysis. About 87.6% wanted to receive kidney transplant; but despite the desire of the patients, this method was initially offered to about 11.5 % of the patients as a possible method of renal replacement therapy. Patients who had desire to receive kidney transplantation were significantly younger, male, married, employed, and had high level of education (P < .05). Conclusion. Although most of the patients wanted to receive a kidney transplant, it was initially offered to a small population. Age, gender, marital status, employment condition, and level of education were significant factors for the patient's tendency to receive a kidney transplant. [ABSTRACT FROM AUTHOR]

Introduction: Diabetes mellitus is the most common single cause of End Stage Renal Disease (ESRD). About 20-30% of patients with Type 1 Diabetes Mellitus (Type 1 DM) develop diabetic nephropathy as a serious complication which is the major cause of morbidity and mortality. Early identification of renal impairment is crucial to prevent the progression of nephropathy to a significant degree, because several interventions have greatest impact if initiated very early in the course of the disease. Aim: To study the correlation of microalbuminuria and serum cystatin C for the early prediction of renal impairment in patients with Type 1 DM. Materials and Methods: This was a cross-sectional study conducted from January 2016 to June 2016 on type 1 DM patients attending Diabetology Out Patient Department (OPD). According to the duration of diabetes, pateints were divided into two groups, Group I with <5 years and Group II with >5 years duration. The patients in each group were categorised as cases and controls, based on the Albumin Creatinine Ratio (ACR), serum urea, Creatinine, cystatin C, glycated haemoglobin (HbA1c), and urine ACR levels were estimated. Student's unpaired t test was used to compare the means between two independent groups. Pearson correlation coefficient was used to estimate the degree of correlation between two quantitative variables. Results: Cystatin C levels in cases (0.89±0.35) when compared to controls (0.67±0.26) in more than five years duration of type 1 DM found to be statistically significant (p <0.05) and positive correlation between cystatin C and ACR (r = 0.4, p<0.05) found to be statistically significant in more than five years duration. It indicates that serum cystatin C levels increases as the values of ACR increases. There was no significant difference in cystatin C levels in patients with less than five years duration of type 1 DM Conclusion: Serum cystatin C may be considered as an early predictor of renal impairment in type 1 DM patients with more than five years duration. However, in this study cystatin C carries no significance in less than five years duration of type 1 DM patients. [ABSTRACT FROM AUTHOR]

[Display omitted] • EDCs are released by medical devices and detected in dialysis fluids. • Patients treated by dialysis are overexposed to seven EDCs. • Strategies to reduce EDCs exposure have been suggested. • Manufacturers must reconsider the conception of medical devices. Endocrine disrupting chemicals (EDCs) were defined as "an exogenous substance or mixture that alters function(s) of the endocrine system and consequently causes adverse health effects". These compounds are mainly eliminated by the renal route. However, patients with end-stage kidney disease treated by dialysis (ESKDD) can no longer eliminate these EDCs efficiently. Furthermore, EDCs exposure could occur via leaching from medical devices used in dialysis therapy. As a result, ESKDD patients are overexposed to EDCs. The aims of this study were to summarize EDCs exposure of ESKDD patients and to evaluate the factors at the origin of this exposure. To handle these objectives, we performed a literature review. An electronic search on PubMed, Embase and Web of science databases was performed. Twenty-six studies were finally included. The EDCs reported in these studies were Bisphenol A (BPA), Bisphenol S (BPS), Bisphenol B (BPB), Nonylphenol, Di(2-ethylhexyl) phthalate (DEHP), Di-n-butyl phthalate (DBP), and Butylbenzyl phthalate (BBP). Regarding the environment of dialysis patients, BPA, BPB, BPS, DEHP, DBP and nonylphenol have been found. Environmental exposure affects EDCs blood levels in ESKDD patients who are overexposed to BPA, BPS, BPB and DEHP. For ESKDD patients, dialyzers with housing in polycarbonate and fibers in polysulfone seem to overexpose them to BPA. Regarding dialysis therapy, peritoneal dialysis seems to decrease patient exposure vs hemodialysis therapy, and hemodiafiltration therapy seems to reduce this exposure vs hemodialysis therapy. Regarding DEHP, levels tend to increase during dialysis and when DEHP plasticizer is used in PVC devices. Finally, in the European Union a regulation on medical devices was adopted on 5 April 2017 and has been applied recently. This regulation will regulate EDCs in medical devices and thereby contribute to reconsideration of their conceptions and, finally, to reduction of ESKDD patients' exposure. [ABSTRACT FROM AUTHOR]

Mitral annular calcification (MAC) is a chronic degenerative condition that is associated with age, chronic kidney disease, diabetes, dyslipidemia, hypertension, and tobacco use. Mobile calcified lesions can be mistaken for endocarditis on trans-thoracic echocardiogram (TTE), creating a unique diagnostic challenge. In this case, we describe a young dialysis patient who presented with dyspnea on exertion with no obvious etiology on initial work-up. TTE was obtained, which showed mobile lesions on the mitral and aortic valves, initially thought to be endocarditis, but later diagnosed as MAC. Trans-esophageal echocardiography (TEE) is a useful modality to differentiate mobile masses on the mitral valve. [ABSTRACT FROM AUTHOR]

Alport syndrome (AS) is a genetic disease with various manifestations, including hematuria, proteinuria, impaired renal function and potential ocular or auditory abnormalities. Mutations in the collagen type IV α 3 chain (COL4A3), collagen type IV α 4 chain and collagen type IV α 5 chain genes encoding the α3, α4 and α5 chains of type IV collagen may undermine glomerular basement membrane (GBM) integrity and cause persistent renal deterioration. In the present study, the case of a Chinese family diagnosed with AS was examined. Pedigree investigations and whole exome sequencing (WES) revealed the presence of two heterozygous mutations (c.2603G>A; p.G868E, and c.583G>A; p.G195S) in the COL4A3 gene. p.G868E was identified as the 'culprit' mutation, whereas p.G195S was identified as an 'auxiliary' mutation for AS with regards to the manifestations observed in the patients carrying each of the gene mutations. In conclusion, these findings suggested that c.2603G>A may be a novel overt pathogenic mutation site for autosomal dominant AS. In addition, WES may be effective for the early diagnosis and medical intervention of AS, and may be widely used for AS prognosis prediction and pre-implantation genetic diagnosis. [ABSTRACT FROM AUTHOR]

Background: Patients with end-stage renal disease are exposed to extreme volume shifts and thereby cardiovascular strain as a consequence of interdialytic weight gain, fluid removal during hemodialysis and also chronic fluid overload. In long-term hemodialysis patients, higher IDWG (interdialytic weight gain) is associated with poor survival and increased cardiovascular death. Patients with the lowest interdialytic fluid retention have the greatest survival. It was found that increased interdialytic volume load is associated with increased both LVMI and FGF-23 level. Objective: To evaluate correlation between hypervolemia, left ventricular hypertrophy and FGF-23 in prevalent hemodialysis patients. Patients and Methods: This cross sectional study was conducted in Ain shams university hospital and Al Agoza hospital, on 60 prevalent hemodialysis patients.Three patient died during the study. Results: FGF-23 had a positive correlation with (weight gain, (PO4) 3-, PTH, IVS, PW and LVMI). Conclusion: FGF-23 might be a marker of volume overload and LVH in ESRD patients, as it positively correlated with (weight gain, IVS, PW and LVMI). FGF-23 is a marker of bone diseases, as it positively correlated with (PO4) 3- and PTH. Volume overload has a negative impact on morbidity and mortality in ESRD patients. [ABSTRACT FROM AUTHOR]

Background: Left ventricular hypertrophy (LVH) is the principal myocardial alteration in patients with ESRD due to multiple preload and afterload factors related to hemodialysis leading to left ventricular diastolic dysfunction manifested by signs and symptoms of heart failure with preserved ejection fraction (HFpEF). The use of echocardiography and tissue Doppler imaging is essential to detect diastolic dysfunction in ESRD patients undergoing hemodialysis as the prevalence of diagnosing HFpEF in ESRD patients is under-estimated. Objective: To evaluate the possible impact of renal replacement therapy in the form of regular dialysis provided to end stage renal disease patients on left ventricular diastolic function by implementing tissue doppler imaging. Patients and Methods: The study included 100 ESRD patients on regular dialysis presenting to the dialysis unit in Ain Shams University Hospitals. The inclusion criterion was end stage renal disease patients with GFR < 15 ml/min/1.73 m2 on regular dialysis for more than 6 months. Excluded patients were those above than 80 yrs old, with hemodynamic instability, arrhythmias, valvular diseases, ischemic conditions, and LV systolic dysfunction. After the hemodialysis session, ECG gated echocardiography was done applying pulsed wave Doppler on mitral valve to detect E/A ratio, continuous wave Doppler on tricuspid valve to calculate TR vmax, and tissue Doppler on lateral mitral annulus to detect e’ and E/e’ ratio. Moreover, left atrial volume index (LAVI) and other standard echocardiographic parameters were measured. Full history and clinical examination including ECG recording was done and blood samples were taken to measure hemoglobin levels. Patients were then stratified according to their diastolic dysfunction grading. Results: Seventy eight percent (78%) of the patients showed diastolic dysfunction including 46 % showed grade I diastolic dysfunction, 26 % showed grade II diastolic dysfunction and 6% showed grade III diastolic dysfunction. Hemoglobin levels showed significant negative correlation with E, E/A, E/E’, LAVI and TR Vmax (r = -0.25, -0.37, -0.29, -0.23 and -0.31 with p 0.012, <0 .001, < 0.003, 0.002 & <0 .001 respectively). Multiple regression analysis revealed smoking, DM, Hb, LVPWd, EF, E/A, LAVI and TR Vmax presented the important determinants of diastolic filling (b = -0.16, 0.15, -0.20, -0.27, -0.25, 0.16, 0.39 & 0.27 and p = 0.002, 0.045, < 0.001, 0.022, < 0.001, 0.039, < 0.001 & < 0.001 respectively). Comparing E/A ratio with E/e’ ratio sensitivities revealed E/A ratio was 28.2% while E/e’ ratio was 74.3%. This was statistically significant showing a difference between the two modalities (χ² = 33.2526 and p = < 0 .0001). Conclusion: In ESRD patients, maladaptive events leading to LVH and diastolic dysfunction occur frequently. Thus, early identification and treatment of factors involved in order to prevent this devastating process. Now it seems that TDI and E, E/A and E/E’ parameters are good instruments for the early detection of LVH and diastolic dysfunction as they are important risk factors for cardiovascular morbidity and mortality in CKD. In comparison with the conventional Doppler techniques, tissue Doppler is a vital tool in diagnosing diastolic dysfunction [ABSTRACT FROM AUTHOR]

Apparent treatment-resistant hypertension (ATRH) is closely related to chronic kidney disease (CKD); however, the long-term outcomes and the effects of improvement in ATRH in patients with CKD are not well understood. We evaluated the relationship between the persistence of ATRH and the progression of CKD. This cohort study enrolled 1921 patients with CKD. ATRH was defined as blood pressure above 140/90 mmHg and intake of three different types of antihypertensive agents, including diuretics, or intake of four or more different types of antihypertensive agents, regardless of blood pressure. We defined ATRH subgroups according to the ATRH status at the index year and two years later. The prevalence of ATRH at baseline was 14.0%. The presence of ATRH at both time points was an independent risk factor for end-point renal outcome (HR, 1.41; 95% CI, 1.04–1.92; p = 0.027). On the other hand, the presence of ATRH at any one of the time points was not statistically significant. In conclusion, persistent ATRH is more important for the prognosis of renal disease than the initial ATRH status. Continuous follow-up and appropriate treatment are important to improve the renal outcomes. [ABSTRACT FROM AUTHOR]