Diabetic nephropathy as a cause of end stage renal disease in El-Minia governorate: Three-year study

The number of patients who have diabetes and end stage renal disease and are being admitted to renal replacement treatment is increasing dramatically worldwide, and in many countries, diabetes has become the single most frequent cause of renal failure. This study assesses trends in incidence of diabetes-related end-stage renal disease in El-Minia governorate during the period of 2003-2005. Cross sectional study structured questionnaires were used that focused on variables suspected as an etiological factors for end stage renal disease. Results, the interviewed patients were 1096 and the total number of diabetic nephropathy patients was 95. The incidence of diabetic nephropathy increased from 5% in 2003 and 6.1% in 2004 to 7.5% in 2005. The mean age of patients with diabetic nephropathy was significantly higher than that of patients with ESRD from other causes. Furthermore, incidence of diabetic nephropathy was mere in urban than in rural areas incidence of diabetic nephropathy in El-Minia governorate increased gradually from 2003-2005. The mean age of patients with diabetes was significantly higher than that of patients with end stage renal disease from other causes and the incidence of diabetic nephropathy was lower in rural than urban areas. More attention should be paid toward diabetic patients to avoid infections causing glomerulonephritis and toward the premature death due to cardiovascular diseases or stroke before ESRD can develop

Renal replacement therapy and increased risk of cardiovascular disease in El-Minia governorate, Upper Egypt

Introduction: End stage renal disease [ESRD] is one of the main health problems in El Minia Governorate Currently, hemodialysis [HD] represents the main mode for treatment of ESRD in El Minia Governorate. El Minia Governorate consists of 9 districts and total population of 4.6 millions

The aim of this study: Is to describe the prevalence rate and etiology of ESRD in patients under Renal Replacement Therapy [RRT] in El Minia Governorate during the year 2005 and risk factors for cardiovascular disease in this group of patients

Material and Method: Patients of ESRD were interviewed and questionnaires were filled out by the investigators. The questionnaire included personal data, past history of relevant diseases, renal biopsy results, ultrasonography, dialysis frequency, lipid profile, ECG, Echocardiography and other data investigating the cause of ESRD and the causes of death

Results: This study included 614 patients, that is 51% of the estimated total number of patients treated by RRT in El-Minia governorate. The prevalence of ESRD in El- Minia governorate is 260/ per million population [PMP]. Most patients are treated by hemodialysis [HD] [97.2%] while only 2.8% are treated by either peritoneal dialysis or renal transplantation. The etiology of ESRD was unknown in 28% of cases while hypertension was responsible for 20.7% of cases, obstructive uropathy 12.7%, chronic glomerulonephritis 10.4%, analgesic nephropathy 6% chronic pyelonephritis 5.8%, and diabetic nephropathy 5%. Other causes such as gouty nephropathy, collagen diseases, toxaemia of pregnancy and lupus nephritis constituted 7% of cases. The prevalence of ischemic heart disease was 16.5%, congestive heart failure 28% Cerebrovascular accidents 5%, the death rate among HD patients during this year was 210/1000

Recommendation: Education program for nephrologists and practitioners should be strengthened with special emphasis on etiological factors leading to ESRD, blood pressure control with focus on systolic pressure appears to be an important strategy to improve outcomes in HD patients, Attempts to establish a program for renal Transplantation should be encourged

Factors associated with the progression of renal disease one year prior to the start of hemodialysis

Chronic kidney disease [CKD] is a worldwide public health problem. The adverse outcome of CKD can often be prevented or delayed through early detection and treatment. Progression of renal failure is characterized by modification of renal structure, which leads to terminal renal insufficiency. Interfering with progression continues to be a major challenge and at the forefront of renal research. Aim of the work: is to determine the decrease in creatinine clearance during the year prior to the initiation of hemodialysis [HD] and to identify factors linked to deterioration of kidney functions in order to slow down the progression of renal disease. Subjects and From January 2002 to December 2003 sixty five patients diagnosed with kidney disease were seen at the outpatient clinic of the internal medicine department, El-Minia University Hospital. They were 41 males [63.1%] and 24 females [36.9%]. The progression of the kidney disease was measured by changes in creatinine clearance. creatinine clearance decreased from 20.7 +/- 8.8 ml/min during the year prior to the initiation of HD to 15.8 +/- 7.8 ml/min at the start of dialysis [p<0.001] with a mean decline of 5.5 +/- 3.4 ml/min. It was found that the variables correlated significantly with creatinine clearance were hematocrite value, LDL as well as systolic and diastolic blood pressure. No relation was found between the progression of renal failure and the etiology of CKD. In This study demonstrates the correlation between anemia, dyslipedemia and the progression of chronic renal failure

Anemia in chronic hemodialysis patients: Comparative study between two therapeutic options

Anemia and malnutrtion are significant complications of hemodialysis patients. Androgens had been used for the treatment of anemia in ESRD before the advent of rHuEPO. The high cost of rHuEPO leads to the reevaluation of androgens as an alternative therapy for anemiain hemodialysis patients, further more the anabolic properties of androgens may exert additional benefits on the nutritional status in this population. Aim of the work is to assess the efficiency of nandrolone decanoate in the treatment of anemia of elderly patients on HD, to determine its influence on anabolic properties and identify those patients on HD for whom androgens could constitute a therapeutic alternative. This work was conducted on 30 patients with ESRD on regular HD, 15 male patients received nandrolone decanoate 200 mg/week I.M. while the other 15 patients [9 males and 6 females] recieved rHuEPO 2000 I.U. S.C. thrice weekly both groups treated for 6 months we have found that after 6 months of therapy the increase in the hemoglobin concentration obtained in both groups was significant as compared to the basal value but with a lower economic cost in the androgen group, In addition to the erythropoeitic action, androgens had a beneficial anabolic effects as evidenced by the significant increase in the serum albumin. The study suggests nandrolone decanoate constitutes a good therapeutic option for the treatment of anemia in elderly male patients on chronic HD, furthermore compared to rHuEPO nandrolone decanoate administration was associated with beneficial anabolic effects