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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]

Background: Worldwide, data are conflicting on the prevalence of Helicobacter pylori (Hp) infection in Hemodialysis (HD) population. In Egypt, the data on this population are rather limited. Objectives: The aim of this cross-sectional study was to screen HD patients with Gastrointestinal (GI) symptoms for the prevalence of Hp infection using non-invasive serological testing for Immunoglobulin G (IgG) antibody and then to compare the screening data with the confirmatory esophagogastroduodenoscopy (EGD) findings. Patients and Methods: From January 2020 to June 2021, the sera of one hundred patients with GI complaints were screened for IgG antibody against Hp, among them fifty patients underwent EGD as per indication. Univariate and multivariate analysis were performed to compare serological versus invasive testing performance for Hp infection. Results: In the present study, (60%) of the screened study population demonstrated a positive IgG against Hp, whereas the EGD findings confirmed Hp infection in (50%) of the fifty patients who underwent a confirmatory EGD. In comparison to EDG findings, IgG Antibody sensitivity and specificity for diagnosis of Hp infection was 65.5 % and 52.4 % respectively. Conclusion: Among the one hundred HD patients screened for IgG against Hp, we found a seroprevalence of 60%; however, the performance characteristics of IgG antibody were limited. Further studies are warranted to explore these findings. [ABSTRACT FROM AUTHOR]

Background: Hemodialysis (HD) seems to be the most often used Renal Replacement Therapy (RRT) modality worldwide, and it is the primary modality in the majority of instances with extended RRT. The ability to provide our patients with high-quality HD treatment while also increasing their chances of survival is heavily reliant on the functionality of the vascular access (VA). Despite the fact that it is a very necessary component of all clinical practise standards, it is the most expensive individual component of RRT. Objectives: This study was aimed at comparing between the group with Angio access failure and group without Angio access failure and predicting Angio access failure among end stage renal failure patients in Southern Egypt. Subjects and Methods: a prospective cohort study among 125 patients with end stage renal failure at Aswan University. The research comprised patients who had NCVA placement [intra-atrial catheter (IAC) and trans-lumbar catheter (TLC)] between January 1, 2020, and December 31, 2020. Results: The duration of previous RRT was significantly higher among the Angio access failure than the group without Angio access failure. In multivariate analysis using logistic regression, the age, duration of previous RRT, diabetes, IHD (ischemic heart disease), PVD (peripheral vascular disease) and CVD (cardiac vascular disease) were significantly direct predictors of the Angio access failure in the first one year. Conclusion: In conclusion the failure of Angio access was positively associated with age, previous RRT and other comorbidities. [ABSTRACT FROM AUTHOR]

Background: Vitamin D deficiency (<20 ng/mL) and insufficiency (20-29 ng/mL) are common among patients with chronic kidney disease (CKD) or undergoing dialysis. Low 25(OH)D has been associated with high bone turnover, secondary hyperparathyroidism (SHPT), decreased bone mineral density (BMD), renal anemia, erythropoietin hypo responsiveness and sleep disturbance in CKD and dialysis patients Methods: This cross sectional study was carried out on 100 End Stage Renal Disease patients on Maintenance Hemodialysis in the Hemodialysis unit of Ain Shams University hospital, Cairo - Egypt. Assessment of serum level of 25(OH) VIT D, and to identify if possible relation between vitamin D deficiency and other parameter like hemoglobin level, Parathyroid hormone, Calcium, Phosphorus, Iron profile, DM, HTN, medications. Results: Vitamin D deficiency is common in end stage renal disease patients on regular hemodialysis, in our study we found that 50% of patients have 25(OH) VIT D deficiency, 34% are insufficient and only 16% was sufficient. There was no significant correlation between the serum level of 25(OH) VIT D and hemoglobin level and iron profile also no significant relation between 25(OH) vitamin D and PTH, calcium, phosphorus. Conclusion: Vitamin D deficiency and other disorders in calcium and phosphorus homeostasis are common in patient with end stage kidney disease on regular hemodialysis. We did not notice any significant relation between the levels of calcium, phosphorus, parathyroid hormone, serum albumin and vitamin D level. No significant relation between vitamin D level and hemoglobin level, iron profile. The National Kidney Foundation guidelines state that optimal 25(OH) D levels should be greater than 30 ng/ml. [ABSTRACT FROM AUTHOR]

Background: According to the WHO there are 185 million people infected with HCV in the world. Egypt has the highest prevalence of hepatitis C virus (HCV) in the world reaching 13% equating to an estimated 12million Egyptians. HCV is one of themain causes of liver cirrhosis and hepatocellular carcinoma. HCV can develop kidney disease because of extrahepatic manifestations of HCV or as a disease process independent of the HCV infection. In addition, hemodialysis has been a risk factor for acquiring HCV infection. The prevalence of HCV infection is high in patients with ESRD, on hemodialysis ranges from 6% to 60% in different parts of the world. Several studies show that patients on hemodialysis have an increased overall mortality risk if they have chronic HCV when compared with those on dialysis who do not have HCV. Antiviral treatment in CKD patients can be complicated because many of the agents used for anti-HCV therapy can accumulate to toxic levels in the setting of renal impairment. Treatment of HCV compensated cirrhosis with the new DAA therapy Qurevo "ombitasvir/paritaprevir/ritonavir" with ribavirin in ESRD was approved inmany countries. Aim of the study: To evaluate the efficacy and safety of Qurevo/Ribavirin regimen in ESRD Egyptian patients who are infected with hepatitis C virus (HCV). Patients and Methods: A prospective cohort study evaluated the outcome of 12-week ombitasvir (NS5A inhibitor)/paritaprevir (NS3/4A protease inhibitor)/ritonavir with ribavirin combination therapy for 50 ESRD patients with HCV at the hepatic virology clinic at Ain Shams University hospital over a period of 15 months (from December 2016 to February 2018). The primary endpoint was sustained virologic response 12 weeks after therapy (SVR12). Results: 50 ESRD patients with a mean age of 51.4 years, range from 23-77 years were enrolled. The SVR12 rate was 96% (48/50); 2 patients had virologic failure. As regards adverse events, the most frequent was fatigue/asthenia in 44 patients (88%) and worsening anemia (Hb dropped to<10 g/dl) in 42 patients (84%). GIT upset occurred in 10 patients (20%), sleep disorders in 8 patients (16%), decreased appetite in 8 patients (16%), respiratory distress in 6 patients (12%), headache, dizziness in 6 patients(12%). Muscle spasms in 4 patients (8%). Itching(pruritis) occurred in 3 patients(6%).2 patients (4%) were non-responders to treatment and another 2 (4%) were relapsers. Death occurred in 4 patients (8%) due to myocardial infarction, pulmonary edema, severe hypotension on hemodialysis sessions, shock due to blood loss in retroperitoneal hematoma following peritoneal dialysis. Hepatic decompensation, hypersenisitivity (angioedema), teratogenicity and drug interactions did not occur in any patient (0%). Other events occurred in 11 patients (22%). They were parenchymal liver changes in ultrasound at the end of therapy after being normal before therapy (in 3 patients), thrombocytopenia, increased alkaline phosphatase, hiccough, deterioration of hypertension, urinary tract infection, lower limb cellulitis, vaginal bleeding, chest infection(in 1 patient each). SVR12 was achieved in 100% of patients who had to stop or modify ribavirin dose;this means that Ribavirin absence didn't affect the sustained viral response in these patients. Conclusion: Our results confirm the efficacy of Qurevo "ombitasvir/paritaprevir/ritonavir" with Ribavirin combination therapy in ESRD patients with HCV infection, with anemia as the most frequent adverse event. [ABSTRACT FROM AUTHOR]

Aim: Congenital anomalies of the kidneys and urinary tract (CAKUT) comprise various entities of structural malformations that result from defects in morphogenesis of the kidney and/or urinary tract. These anomalies are the most commonly diagnosed malformations in the prenatal period and constitute the leading cause of end-+stage renal disease (ESRD) in children, worldwide. This prospective study was performed to report the patterns of clinical presentation and diagnosis of infants and children with such malformations., Methods: Patients with suggestive features of CAKUT, presenting to Cairo University Children Hospital over one year duration were investigated and categorized based on underlying renal structural/functional malformation and associated extra-renal anomalies., Results: One hundred and seven CAKUT children were enrolled in the study. Familial clustering was identified in 14% of the cohort and syndromic CAKUT accounted for 31.8% of cases. Different anomaly entities have been identified; posterior urethral valves (PUV) being the commonest detected abnormality (36.4%). Of note, 9.3% of cohort patients had ESRD at presentation, of which 60% had PUV as their primary renal disease. Obstructive cases were noted to present significantly earlier and attain advanced CKD stages rather than non-obstructive ones., Conclusion: CAKUT is a clinically heterogeneous group of diseases with diverse clinical phenotypes. More efforts should be aimed at improving antenatal detection as well as classification with comprehensive reference to the clinical, genetic and molecular features of the diseases. The high frequency of familial and syndromic CAKUT among studied patients is seemingly a convincing reason to pursue the underlying genetic defect in future studies., (© 2015 Asian Pacific Society of Nephrology.)

Context: The role of the angiotensin II type 1 receptor (AT1R) gene polymorphism, A1166C, has been shown to be associated with end stage renal disease (ESRD) and its progression. There is also some evidence that HLA class II alleles are associated with ESRD independent of other factors., Objective: To examine the association between AT1R gene polymorphism in the susceptibility and progression to ESRD in patients with chronic renal failure and to investigate if the AT1R genotypes and HLA-DR alleles predict the time to ESRD., Materials and Methods: Genotyping was performed in 50 ESRD patients and 44 control subjects for the AT1R A1166C gene polymorphism using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). ESRD patients were examined for HLA-DRB1 alleles according to a reverse hybridization line probe assay., Results: Allele and genotype frequencies of the AT1R polymorphism did not differ significantly between ESRD patients and controls. Furthermore, there was no association between the AT1R gene polymorphism or HLA-DRB1 alleles with the time to the occurrence of end stage failure., Discussion and Conclusion: We concluded that the AT1R genotype does not contribute to the genetic susceptibility of ESRD and is not associated with progression of chronic kidney failure to ESRD.