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   Table of Contents - Current issue
April-June 2020
Volume 20 | Issue 2
Page Nos. 91-125

Online since Monday, April 27, 2020

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Intradialytic changes in endothelin-1 level and its relation with intradialytic hypertension p. 91
Magdy ElSharkawy, Heba Abou Zaghla, Ahmed A Emara, Youssef El-Emary, Mohamed Hassan
Background Intradialytic hypertension (IDH) is a major problem affecting 5–15% of patients with end-stage renal disease on maintenance hemodialysis (HD). We evaluated the changes of endothelin-1 (ET-1) levels during HD and its relation to IDH. Patients and methods We divided 48 stable HD patients into two groups: group I included 24 HD patients with IDH, and group II included 24 HD patients with well-controlled blood pressure (BP). Diabetic patients, patients taking angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARBs), and patients with severe infection, malignancy, or having decompensated liver cell failure were excluded from this study. For all patients, BP measurement was done before HD session and every half an hour throughout the sessions. ET-1 level was measured using enzyme-linked immunosorbent assay technique; three samples (before session, when BP rises during session, and at end of session) were taken from group I patients, and one sample was taken before the session in group II patients. Results Group I had significantly lower dry weight than group II (59.9±16 vs.71.5±11 kg) but a significantly higher ultrafiltration volume (2 vs. 1.5 l). There was a significant positive correlation between basal ET-1 and diastolic blood pressure after dialysis (r=0.51, P<0.05). In this study, basal ET-1 level had a significant moderate diagnostic performance in prediction of IDH (P< 0.001). Basal ET-1 more than or equal to 100 pg/ml had 100% specificity, 75% sensitivity, and 87.5% diagnostic accuracy in prediction of IDH, leading to suggestion that ET-1 was a significant risk factor for having IDH (P<0.05). Conclusion High ET-1 is a significant risk factor for having IDH, and basal ET-1 level had a significant moderate diagnostic performance in prediction of IDH.
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Role of engulfment and cell motility 1 gene polymorphism in type 2 diabetic nephropathy and its association with renal biomarkers: case–control stody p. 98
Hawraa J Mohammed, Riyadh M Al-Saegh, Narjis H Al-Saadi
Background Diabetic nephropathy (DN) is a serious kidney-related complication of diabetes. It is also called diabetic kidney disease. Up to 40% of people with diabetes eventually develop kidney disease. Several genome-wide association studies have introduced engulfment and cell motility 1 (ELMO1) as a candidate gene that is associated with DN. This study assessed the association of ELMO1 gene polymorphisms with DN to investigate the effects of ELMO1 gene on susceptibility to DN in Kerbala/Iraqi province. Aim The current study aims to identify the role of ELMO1 gene polymorphism, single nucleotide polymorphism (SNP) rs741301, as a candidate gene for susceptibility to DN among patients with type 2 diabetes mellitus and its association with the development and progression of this disease and to verify the relationship between the investigated SNPs of ELMO1 gene with the phenotype changes in particular kidney function tests and other kidney biomarkers that may be seen in patient. Patients and methods A case–control study was conducted for a period of 14 months, starting from January 2018 to March 2019, in Al-Husain Medical City and Al-Kafeel Super Specialty Hospital in Kerbala. A total of 72 participants were divided into two groups: 36 patients with type 2 diabetes with nephropathy and 36 nonnephropathic patients with type 2 diabetes. DNA was extracted from the blood, and then genotyping of the SNP rs741301 was carried out by Tetra ARMS-PCR by using special primers. Results The genotype and allele frequencies were examined under the codominant, dominant, and recessive models with the use of multinomial logistic regression analysis. The patient with DN with the heterozygous genotype GG+AG (odds ratio=5.28, confidence interval=1.35–20.73, P=0.017) were higher than diabetic patients with GG+AG (odds ratio=4.231, confidence interval=1.06–16.97, P=0.042) under with dominant model. Conclusion SNP rs741301 of ELMO1 gene was associated with DN due type 2 diabetes complication in Kerbala/Iraqi province.
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Acute kidney injury in intensive care unit patients in Benha University Hospitals p. 103
Ayman M El-Badawy, Ahmed E Mansour, Rasha O Abdelmoniem
Background Acute kidney injury (AKI) is classically described as abrupt or rapidly reversible reduction of excretion of nitrogenous waste products including urea, nitrogen, and creatinine. In critical care setting, patients with AKI constitute an important subgroup in that they have higher short-term and long-term mortality, prolonged hospital stay, and more resource consumption. Risk factors for AKI in patients with severe illness are multifactorial, including underlying certain predisposing factors, as aged patients tend to acquire AKI more than younger patients, together with underlying comorbidities AKI is common and carries a high mortality rate. Most epidemiological studies were retrospective and were done in Western populations. Aim The aim was to highlight the risk factors, mechanisms, and prognosis in AKI in patients in ICU. Patients and methods This is a prospective, observational study that was carried out in ICU, Benha University Hospitals, from January 2018 to July 2018. This study included 50 critical ill patients admitted to ICU. Oral and written consent was taken from every participant after explaining the procedures of the analysis. All patients were clinically evaluated and had routine assessment. Results The mean age of our studied population was 56.3±6.8 years, demonstrating a significant trend toward an increased number of AKI cases with older age. Males represented 68.9% of the included patients, and 62% of patients with AKI had a history of diabetes mellitus. Mortality was evident in 14% of patients with AKI. Patients with AKI with older age, male sex, diabetes mellitus, chronic obstructive pulmonary disease, congestive heart failure, mechanical ventilation, and vasopressor were significantly associated with renal replacement therapy. Conclusion AKI was associated with high mortality rate, and early identification may cause a dramatic decrease in mortality and morbidity, which could be expected in these high-risk patients.
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Insulin resistance in patients with end-stage renal disease on hemodialysis: effect of short-term erythropoietin therapy p. 111
Heba E Kasem, Walid Abd El-Mohsen Shehab-Eldin, Islam S Shebl, Ahmed Abd El-Rahman Sonbol, Mai A Kamel
Background Insulin resistance (IR) is a characteristic feature of uremia. Both IR and metabolic syndrome are considered independent predictors for cardiovascular events and mortality in patients with chronic kidney disease. Few studies have shown a favorable effect of erythropoietin (EPO) in decreasing IR. We hypothesized that short-term treatment with EPO can lead to improvement of IR in patients with chronic kidney disease. Patients and methods Patients were categorized into two groups: 20 hemodialysis patients (HDP) not receiving EPO (control) compared with other 40 HDP divided into two subgroups (20 diabetics and 20 nondiabetic), both receiving EPO (intervention group) all over the duration of the study, which extended for 6 months. All patients were subjected to history taking, full clinical examination, as well as laboratory investigations. Results All baseline results of parameters of glycemic control showed significant stepwise increase from nondiabetic intervention group, to control group, and then to diabetic intervention group. homeostatic model assessment of insulin resistance (HOMA-IR) was 1.64±0.88, 6.14±0.46, and then 10.78±2.84, respectively. On comparing the results before and after EPO therapy in both intervention groups, there was a significant improvement in IR in both groups. HOMA-IR was 10.78±2.84 and 5.52±161 (P<0.001) before and after intervention, respectively, for diabetic patients, whereas it was 1.64±0.88 and 0.8±0.28 (P<0.001) before and after intervention, respectively, for nondiabetic patients. Glycated hemoglobin, fasting insulin level, as well as fasting and postprandial glucose measurements, all in both preintervension and postintervention settings were independent predictors for HOMA-IR after intervention in all 40 patients of both intervention groups. Conclusion EPO treatment in HDPs is followed by improvement of IR in diabetic as well as nondiabetic patients with end-stage kidney disease and on hemodialysis.
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Comparing high-dose and low-dose intravenous iron therapy in hemodialysis patients in Benha city, Egypt p. 120
Mohamed E.-T Ibrahim, Hassan G AbdEl-Salam, Mahmoud S Fathy, Ahmed E Mansour
Background Since the introduction of erythropoiesis-stimulating agents for the management of anemia in patients with chronic kidney disease (CKD), intravenous (i.v.) iron has been universally used, especially with hemodialysis (HD) patients, as their average daily losses of iron typically exceed the oral absorption of iron. The maintenance i.v. iron regimens vary widely between countries and even among HD centers of the same country. Aim The aim of this study was to find out if high-dose i.v. iron will be superior to low-dose i.v. iron for treating anemia in HD patients. Patients and methods This study was carried out at HD units of Benha University Hospitals and Benha Teaching Hospital from March 2019 till September 2019. It was carried out on 100 patients with CKD stage V on HD, who were subdivided into two groups. Group Ι: 50 patients with CKD stage V on HD who were eligible for low-dose i.v. iron therapy. Group П: 50 patients with CKD stage V on HD who were eligible for high-dose i.v. iron therapy. Results There was an improvement of hemoglobin, serum ferritin, and transferrin saturation after treatment with low-dose and high-dose iron therapy. However, the high-dose iron therapy was associated with a high statistically significant improvement compared with low-dose iron therapy. Conclusion High-dose i.v. iron was superior to low-dose i.v. iron for treating anemia in HD patients.
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