Comparison of arteriovenous fistulae having blood flow equalto and higher than 800 ml / min as regards clinical and laboratory parameters

Background: According to KDOQI guidelines, the lower limit of arteriovenous fistula blood flow accounting for 600 ml / min. We have observed that this limit was not enough, at least for our patients. The aim of this work was to prove the hypothesis that this limit must be higher for performing adequate dialysis

Patiemts and methods: Fifty patients on prevalent hemodialysis were included in this study. They were divided into 3 groups; group I: 12 patients formed low flow group, group II: 18 patients formed moderate flow group, and group III: 20 patients formed high flow group. Complete physical examination including clinical fistula examination for patency, were performed for all patients. Laboratory tests performed for all patients included :urea reduction ratio [URR %], serum calcium ,serum phosphorus, calcium - phosphorus product, serum albumin, hemoglobin, serum Iron, serum ferritin, TIBC, Transferrin saturation [TSAT %], Kt / V [number used to quantify hemodialysis treatment adequacy], serum creatinine, together with blood urea before and after session. Fistula blood flow and static venous pressure were determined by Doppler ultrasound. Fistulogram was performed to confirm the fistula stenosis site, whenever detected by Doppler

Results: Mineral bone profile markers, Iron profile markers, together with malnutrition - inflammation complex indicators, were all in favour of moderate and high flow groups, mainly the moderate flow group II due to the presence of much less complications than the other groups

Conclusion: We have to try to perform arteriovenous fistulae for ESRD patients needing regular dialysis, in such a way that fistula blood flow is above 800 ml / min, and it is better to be within the range of 801 - 1600 ml / min

Effect of Endotoxemia on Cardiac Disease in high and low flux Hemodialysis patients

Background: endotoxemia can be the missing link between ESRD and cardiac disease, the first cause of death in hemodialysis patients

Patients and methods: patients were recruited from Ain Shams University Hospitals, hemodialysis units. 120 patients on prevalent HD were enrolled in the study: 31 cardiac patients on high flux HD [group A], 29 cardiac patients on low flux HD [group B], 32 non-cardiac high flux HD [group C], and 28 non cardiac low flux HD [group D] . For all patients we measured: Hb, URR, serum albumin, HsCRP, predialysis and postdialysisa endotoxin, endotoxin delta change, echocardiography, and ECG

Results: we found that cardiac high flux and low flux groups had higher endotoxemia levels than non cardiac high flux and low flux groups

Conclusion: High flux hemodialysis patients had higher accumulated endotoxin than low flux hemodialysis patients, within either cardiac or non - cardiac groups

Study of cardic valvular calcification in ESRD patients on regular hemodialysis [a single center study]

Cardiac valve calcification are common among patients with chronic kidney disease [CKD]. Risk factors include alterations in calcium and phosphorus metabolism, elevated calcium phosphorus product and persistent elevations in plasma parathyroid hormone [PTH]. Echocardiography is a simple and inexpensive method for detection of valvular calcifications as suggested by KDIGO guidelines. 60 Patients on regular HD constituted group A [36 males and 24 females] and 25 healthy volunteers constituted group B. Group A was subdivided into: Group I: 21 patients with no valvular calcification, group 2: 26 patients with aortic valve calcification and group 3: 13 patients with aortic and mitral valve calcification. For all, the following was done: clinical examination, serum Ca, serum P, serum albumin, serum creatinine, BUN and PTH level in blood. M-mode echo cardiography was done for all. Age, duration of dialysis and duration of 1ry kidney disease was higher in group 2 and 3 compared to group 1 [p = 0.0001]. Calcium was higher in group 2 than group 1 [p = 0.09] and group 3 [p = 0.004] than group I phosphorus was higher in group 2 and 3 than group 1 [P = 0.001]. P was higher in group 3 than group 2 [p = 0.0001]. Ca x P was higher in group 2 and 3 than group 1 [p = 0.0001], in group 3 than group 2 [p = 0.01] PTH was higher in group 1 than group 2 [p = 0.06]. Cardiac dysfunction by echocardiography was least in group 1, increasing in group 2 and being highest in group 3. It was found that calcified valve groups has taken higher doses of Calcium and Vitamin D3. We have to take care on prescribing Ca and vitamin D3 to ESRD patients on regular HD

Study of erythropoeitin on IGM serum levels in HCV positive patients on regular HD

Both uremia and HD process cause immunosuppression in HD patients. There was significant increase of total serum IgG and IgM levels found in patients with chronic HCV compared with healthy controls. There is evidence pointing to direct effect of rHuEPO upon B cells. High doses of recombinant human erythropoietin [rHu EPO] enhanced in vitro Ig production and proliferation of various plasma cell lines, as well as human plasma cells generated in vitro. Study was conducted at hemodialysis Unit of Shubra Municipal hospital between August 2010 to February 2011. 30 HCV positive patients on regular hemodialysis were included in study, using bicarbonate dialysate and polysulfone membrane dialyser, for 4 hours 3 times weekly. Patients were divided into 2 groups: first group: 15 patients on EPO therapy. 4000 IU/week and second group not taking EPO for all patients full clinical examination was done, CBC, BUN, serum creatinine, ALT, AST, serum albumin and serum IgM by ELISA [quantitative assay], were done. There was no significant difference between 2 groups as regards age, sex distribution, WBC count, ALT, AST, serum creatinine, BUN and IgM serum level. First group had borderline significant higher Hgb and Hct than second group [p = 0.056]. Females didn't have higher serum IgM level than males [p = 0.403]. All correlations of IgM serum level to other parameters of study were irrelevant. Uremia seems to protect ESRD patients on regular HD from complications of HCV and also EPO effect on Ig serum levels

Impact of tissue typing matching on early graft function

Our study was conducted in Nasser institute. 60 patients were included in the study. They -were on regular hemodialysis and underwent kidney transplantation [46 males and 14 females], with a mean age of [32.03 +/- 10.57] years. 17 cases had related living donors and 43 cases had unrelated living donors. Patients were followed for six months. There was non significant relationship [P>0.05] between Zero match, one mismatch out of 6, two mismatches out of 6 [of HLA-A, HLA-B and HLA-DR] and the survival of the graft. Also there was only significant difference between acutely rejected grafts and non-rejected grafts [P<0.05], with only one successful match out of 6, being having even more successful matches out of 6 but didn't have significant effect on survival of the graft. Having more than one halotype or less, in common between donor and recipient at tissue matching didn't differ much on outcome of the graft [P>0.05]- Being related or unrelated donors, gender of donors and recipients and blood grouping didn't affect much the outcome of the graft [P>0.05]. Cases with more than 1 successful match out of 6 had significant difference in serum creatinine between rejected and non rejected grafts

Effect of haemodialysis on intra dialytic calcium, phosphorus, magnesium, levels in relation to autonomic nervous system activity

Autonomic nervous system dysfunction is common in uremia and in patients under hemodialysis. Changes in serum calcium, serum phosphorus and serum magnesuim always occur during hemodialysis. The relation between these changes and autonomic nervous system activity during hemodialysis has not been fully studied. This study was carried out on 30 patients with chronic renal failure on regular hemo- dialysis with nearly similar age group. We measured serum calcium, serum phosphorus and serum magnesium throughout the session [at predialysis state, middialysis state: after 2 hours of the session and postdialysis: at the end of the hemodialysis Session]. We have also assessed autonomic function [sympathetic by cold pressor test and parasympathetic by Valsalva maneuver test]. Autonomic function tests were assessed at predialysis state, middialysis state and postdialysis state. Calcuim level uncreased throughout the session [P<0.05], phosphorus leuel and Magnesium levels decreased, [P<0.001] and [P<0.05], throghout session . As reguards parasympathetie dysfunetion, there was a significamt relation [P<0.05] with calcuim changes at predialytic and post dialytic states, a highly significant relation [P<0.001] with phosphorus and [P<0.05] with magnesiun, both at predialysis states. Concerging sympathetie dysfunction, there was a significant relation [P<0.05] with calcium levels at end of session. There was a signifcant relation [P<0.05] with predialytic and postdialytic phosphorus levels .There was also significant relation [P<0.05] with predialytic magnesium level

Comparison of intradialytic calcium changes between bicarbonate dialysate and acetate dialysate in chronic hemodialysis patients

Renal osteodystrophy affects patients with end- stage renal failure, resulting in significant skeletal and extra- skeletal morbidity. The aim of the work is to study the intradialytic changes of calcium, phosphorus and parathyroid hormone [PTI-l] in acetate and bicarbonate dialysis. The present study was conducted on 10 chronic renal failure patients [their age ranged from 19 to 60 years and consisted of 7 males 3 females] selected from Ain Shams University Specialized Hospital on regular hemodialysis thrice weekly 4 hours each, first using acetate dialysate and investigations were done then patients were shifted to bicarbonate dialysate and the same investigations were done [Ionized calcium, phosphorous and parathyroid hormone] measured at start of hemodialysis session, after 2 hours from start of session and at the end of session. All patients were ordered to fix their dry weight, protein diet [about 0.8-1gm/Kg/day] and current medications. Non of patients had diabetes, neoplasia, liver disease, cachexia or had been previously parathyroidectomised. This study demonstrated that, calcium level significantly increased in bicarbonate dialysate session and did riot significantly increase in acetate dialysate sessions. Phosphorus level significantly decreased in both acetate and bicarbonate session. PTH level did not significantly decrease in both types of dialysate but in three patients [one in bicarbonate and 2 in acetate], PTH level was markedly raised

Effect of ACE inhibitors on creatinine clearance and albuminuria in diabetic nephropathy

30 diabetic female patients were studied for the effect of Ramipril on creatinine clearance and albuminuria, they all were type 2 diabetes mellitus and were on oral hypoglycemic drugs. They all had variable degrees of hypertenison. Ramipril was taken for 3 months in a variable doses between 5 and 10 mg/day. Creatinine clearance and albuminuria were determined before and after treatment. Patients were divided into 3 groups: Group 1: 10 patients with albuminuria and mild hypertension. Group 2: 10 patients with albuminuria and moderate hypertension. Group 3: 10 patients with macroalbuminuria and moderate to severe hypertension. In our study, Group 1 has made maximum benefit of Ramipril as regards highly significant decrease [P= .002] of creatinine clearance and of albuminuria which improved significantly [P=.001]. Group 2 had a lesser success with only decrease of albuminuria significantly [P=.005] but with insignificant decrease of level of creatinine clearance. Group 3 with macroalbuminuria did not benefit from Ramipril effect on albuminuria but there was a significant decrease in creatinine clearance below normal levels [P=.001]. Early and tight control of blood pressure by Ramipril is needed to achieve a success in treating diabetic nephropathy with microalbuminuria. In our study, patients with macroalbuminuria did not benefit from Ramipril treatment