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Background: Hyperuricemia was found to be associated with hypertension, coronary heart disease, metabolic syndrome and chronic kidney disease. However there are no specific data about the relationship of uric acid to cardiovascular disease and mortality in ESRD patients on chronic hemodialysis. So, we aimed to study the impact of hyperuricemia on cardiovascular system in chronic kidney disease and in ESRD patients on regular hemodialysis Patients and methods: This study included 100 patients in Ashmoun hospital, nephrology department. Patients were chosen and divided into two groups: Group A, 50cases with chronic kidney disease and Group B, 50cases of ESRD on regular hemodialysis. All cases were subjected to full clinical examination, measurement of eGFR, laboratory tests for blood urea, serum creatinine and serum uric acid and ECG. Results: Serum uric acid was significantly higher in dialysis group than CKD group (p<0.01). There was a highly significant correlation between uric acid and both systolic and diastolic blood pressure in Group A (all p values <0.01). Also, there was a significant correlation between serum uric acid and eGFR (p<0.05).No significant difference found between Group A and group B as regards ECG findings (p>0.05). Conclusion: In cases of CKD uric acid is involved in the pathogenesis of renal failure and hypertension. In patients with ESRD, hyperuricemia is not a risk factor for the development of cardiac disease; but it shows reversed epidemiology and becomes a marker of good nutritious status. Further studies should be done on wider scales to evaluate the impact of hyperuricemia on cardiovascular system in hemodialysis patients. [ABSTRACT FROM AUTHOR]

Background: Hyperphosphatemia remains a common problem in patients on maintenance dialysis and contributes to the development of secondary hyperparathyroidism. Current therapies for the treatment of hyperphosphatemia are frequently insufficient to achieve the recommended K/DOQI goal of maintaining serum phosphorus level between 3.5 and 5.5 mg/dl. Niacinamide inhibits intestinal sodium/ phosphorus co transporters and reduces serum phosphorus level in some clinical studies. So, we aimed to evaluate the safety and the efficacy of nicotinamide as adjunctive therapy to calcium carbonate (as calcium based phosphate binder) in hemodialysis patients. Methods: Sixty hemodialysis patients with serum phosphorus level ≥ 5.0 mg/dl were randomly assigned to 8 weeks of the study. Patients were divided into two groups: (group I) (control group): 30 cases calcium carbonate only and (group II) (study group): 30 cases received a combination of calcium carbonate and nicotinamide. Nicotinamide dose was started as 500mg/day and increased on 8th day to 1000 mg/day. Results: In the study group (nicotinamide group): serum phosphorus level fell significantly (p<0.001), calcium x phosphorus product dropped significantly (p<0.001), with a significant elevation of serum calcium (p<0.05). In the control group: there was insignificant change in former parameters (p values>0.05). Intact parathyroid hormone, uric acid, platelet count, total cholesterol, hemoglobin, ASAT, and ALAT and lipid profile remained insignificantly changed in both groups. Diarrhea, flushing and skin rash were the major adverse effects seen with nicotinamide therapy resulting in early withdrawal of 4 patients from the study. Conclusion: In hemodialysis patients, nicotinamide in single dose of 1000 mg daily can effectively reduce serum phosphorus level when administered with calcium carbonate (as phosphate binder) with less potential side effects reported. [ABSTRACT FROM AUTHOR]