Effect of vitamin D supplementation on management of anemia in hemodialysis patients with vitamin D deficiency: A double-blind, randomized, controlled trial.

INTRODUCTION: Anemia and vitamin D deficiency are common problems among hemodialysis (HD) patients. This study aimed to assess the impact of correction of vitamin D deficiency with vitamin D supplementation on the improvement of anemia in patients with end-stage renal disease (ESRD) on maintenance HD. METHODS: This double-blind, randomized, controlled study included 100 anemic HD patients with vitamin D deficiency who were randomly divided using the closed envelop method into two groups (1:1). The first group received vitamin D (50,000 IU) monthly for 6 months, and the other group received a placebo for the same period. 25-Hydroxyvitamin D (25(OH)D) levels were measured for both groups at the beginning of the study and after 6 months at the end of the study. Hemoglobin (Hb) concentrations were recorded monthly. FINDINGS: Vitamin D supplementation during the period of the study increased 25(OH)D levels in the vitamin D group more than the placebo group (p > 0.001). Serum ferritin, serum iron, and transferrin saturation did not differ significantly between both groups during the period of the study. Hb concentration in the vitamin D group increased more than that in the other group over the period of the study, and there was a statistically significant difference between the two groups in all durations of follow-up. Erythropoietin (EPO) dosage requirements were found to be lower in the vitamin D group than in the placebo group, and this was statistically significant (p > 0.001). DISCUSSION: Vitamin D supplementation in anemic ESRD patients on HD with vitamin D deficiency or insufficiency is safe and effective in improving anemia and decreasing EPO dosage.

Urinary congophilia in pregnancy: a marker of kidney injury rather than preeclampsia.

BACKGROUND: The differentiation between preeclampsia and similarly presenting kidney disease in pregnancy is a diagnostic challenge. Although some laboratory tests have been utilized, globally validated tools are yet needed, particularly in resource-limited settings. Congophilic proteins are abundantly detected in the urine of pregnant women who develop preeclampsia that is thought to be a marker of disease process. The present study aimed to assess the diagnostic and predictive utility of urinary congophilia in pregnant women with hypertensive disorders of pregnancy as well as kidney diseases. METHODS: This cohort study included 157 pregnant women, classified as healthy controls ( n  = 38), preeclampsia/eclampsia ( n  = 45), gestational hypertension ( n  = 9), chronic hypertension ( n  = 8), chronic kidney disease (CKD) ( n  = 27), and pregnancy-related acute kidney injury (PR-AKI) ( n  = 30). Urinary congophilia was assessed by Congo Red Dot Blot assay. RESULTS: Congo red retention (CRR) values were significantly higher in women with preeclampsia/eclampsia ( P  ≤ 0.001), chronic hypertension ( P  = 0.029), gestational hypertension ( P  = 0.017), CKD ( P  ≤ 0.001), PR-AKI secondary to preeclampsia ( P  ≤ 0.001), and PR-AKI secondary to other causes ( P  = 0.001), compared with healthy controls. Women with preeclampsia, CKD, and PR-AKI (non-preeclampsia related) exhibited the highest levels of CRR. CRR positively correlated to proteinuria ( P  = 0.006) and serum creatinine ( P  = 0.027). CRR did not significantly vary between women who presented antepartum and those presented postpartum after removal of the placenta ( P  = 0.707). CRR at a cut-off point of at least 1.272 had 91% specificity and 61.1% sensitivity in predicting renal recovery in PR-AKI patients. CRR had a poor specificity in discriminating preeclampsia from the other clinical presentations. CONCLUSION: Urinary congophilia could not discriminate preeclampsia from similarly presenting kidney diseases in pregnancy. Further studies are needed to improve differentiation of these conditions.

Management of pre-renal transplant secondary hyperparathyroidism: parathyroidectomy versus cinacalcet.

Background: Secondary hyperparathyroidism is a common consequence of end-stage renal disease. Despite the efficacy of kidney transplantation in treating renal failure, many transplant recipients still suffer from persistent or tertiary hyperparathyroidism. Furthermore, the impact of secondary hyperparathyroidism therapy choices on other renal transplant outcomes is poorly understood. Methods: We retrieved the clinical data of 334 patients who received a kidney allograft between January 2007 and December 2014 at the Sheffield Teaching Hospitals, NHS Foundation Trust, United Kingdom. We identified three groups: parathyroidectomy group (34 patients), including patients who had parathyroidectomy before transplantation; cinacalcet group (31 patients), including patients who received cinacalcet before transplantation; and control group (269 patients), including patients who receive a transplant in the same period but did not have any evidence of hyperparathyroidism. We reviewed the demographic data, biochemical parameters and graft survival of all groups. Results: Patients who underwent parathyroidectomy before transplantation had significantly better post-transplant calcium and parathyroid hormone levels than patients in the cinacalcet group (p=0.003). In addition, a significantly lower number of patients had tertiary hyperparathyroidism in the parathyroidectomy group than in the cinacalcet group at 1 year of follow-up (p=0.001). However, short-term and long-term graft survival was comparable in all groups. Conclusions: Renal allograft survival was comparable in all groups. However, tertiary hyperparathyroidism was less likely to occur in patients who underwent parathyroidectomy than in those who were administered cinacalcet.

Role of detached podocytes in differentiating between minimal change disease and early focal segmental glomerulosclerosis, can we rely on routine light microscopy?

BACKGROUND: Detachment of podocytes represents a turning point in the development of glomerular sclerosis and consequently, of CKD progression. Furthermore, detachment may differentiate minimal change disease (MCD) cases-which have only podocyte effacement-from early focal segmental glomerulosclerosis (FSGS) in which effacement and detachment are observed by electron microscopy. Noteworthy, it is not uncommon for early FSGS to present with clinical presentation and light microscopy (LM) pictures identical to MCD. In our routine practice, we often find cells that lie freely in Bowman's space by LM. In this study, we try to determine whether these cells are detached podocytes that are worth reporting or just an artifact that can be ignored. METHODS: To the best of our knowledge, no study has discussed the accuracy of LM in detecting detached podocytes by the routinely used stains. We retrospectively selected 118 cases that were diagnosed as MCD by LM, and searched for detached cells in Bowman's space in their archived, routinely stained LM slides. After that, we tried to find any correlation between the clinical course, detached cells in LM picture and the EM reports. RESULTS: LM can significantly detect detached podocytes with a positive predictive value of 93%, specificity of 85%, and sensitivity of 46%. Significant correlations were found between detached cells and degree of proteinuria and late steroid resistance. CONCLUSION: Detecting detached podocytes by LM is a specific finding that must be reported whenever detected, as it predicts response to steroids and may be able to differentiate MCD from early FSGS by identifying patients who could have podocytopenia.

The Relation of Serum Dehydroepiandrosterone Sulfate Level to Protein Energy Wasting in Hemodialysis Patients.

Protein-energy wasting (PEW) is a major risk for morbidity and mortality in hemodialysis (HD) patients. The change in the concentration of dehydroepiandrosterone sulfate (DHEA-S) may play a role in PEW. The aim of this work was to study the possible relationship between serum DHEA-S levels and various nutritional and inflammatory parameters in a cohort of HD patients. In total, 78 HD patients (47 males and 31 females) were included in this crosssectional observational study. In addition to taking their history, clinical examinations, and routine laboratory investigations, the nutritional status was assessed, and their serum DHEA-S was measured. Nutritional status was assessed by anthropometric measures, bioelectrical impedance analysis, malnutrition inflammation scores, and subjective global assessments. A diagnosis of malnutrition was made based on the recommendations of the International Society of Renal Nutrition and Metabolism. The relationship between DHEA-S and various nutritional parameters was analyzed. Eighteen patients (23.1%) suffered from PEW. Those with PEW had a longer duration of HD (P = 0.04), and lower serum levels of creatinine (P = 0.003), hemoglobin (P = 0.01), albumin (P <0.0001), cholesterol (P = 0.02), and DHEA-S (P = 0.01). Among the variables, serum DHEA-S levels were significant predictors of PEW in this cohort (odds ratio: 0.976; 95% confidence interval: 0.954-1.0; P = 0.04). PEW is frequently encountered in HD patients. Decreased serum DHEA-S levels were associated with PEW in male HD patients. Further studies are needed to assess the effect of hormone supplementation on this serious disorder in HD patients.

Is health-related quality of life associated with adequacy of hemodialysis in chronic kidney disease patients?

INTRODUCTION: Monitoring Health Related Quality of Life (HRQoL) in different stages of chronic kidney disease is advised by all nephrology societies. We aimed to study the relation between quality of life and dialysis adequacy. METHODS: One hundred patients (51% males), on regular hemodialysis 3/week for > 6 months in two hospitals were included. Single pool Kt/V was used to assess dialysis adequacy. Patients were grouped into 3 divisions according to Kt/v: Group A > 1.5 (n = 24), group B 1.2-1.5 (n = 54) and group C < 1.2 (n = 22). KDQOL-SF™ questionnaire was used to study quality of life in our groups. Group C was reassessed after 3 months of improving Kt/v. RESULTS: Mean values were: Kt/V (1.48 ± 0.41), Cognitive Function (84.27 ± 9.96), Work status (30.00 ± 33.33), Energy (45.70 ± 13.89), Physical Function and Role limitations due to physical function (45.30 ± 12.39 and 31.25 ± 19.26, respectively). Group A had significantly higher scores of KDQOL-SF except Role limitations due to Physical Function. All subscales improved in group C after Kt/v improvement except 3 subscales, namely, work status, patient satisfaction and role limitation due to physical and emotional functions. CONCLUSION: Inadequate HD badly affects quality of life and improving adequacy refines many components of quality of life.

Relation of Wnt Signaling Pathway Inhibitors (Sclerostin and Dickkopf-1) to Left Ventricular Mass Index in Maintenance Hemodialysis Patients.

BACKGROUND: Left ventricular hypertrophy (LVH) is common in hemodialysis (HD) patients. It predicts poor prognosis. Several inhibitors regulate Wnt canonical pathways like Dickkopf-related protein-1 (Dkk-1) and sclerostin. OBJECTIVES: To investigate the relationship between serum sclerostin, Dkk-1, left ventricular mass (LVM), and LVM index (LVMI) in HD patients. METHODS: This is a cross-sectional study including 65 HD patients in our HD unit. Patients were divided into two groups according to LVMI (group 1 with LVMI < 125 gm/m2 (N = 29) and group 2 with LVMI > 125 gm/m2 (N = 36)). Echocardiographic evaluation of the LVM, aortic, and mitral valves calcification (AVC and MVC) was done. Serum levels of sclerostin and Dkk-1 and patients' clinical and biochemical data were recorded. RESULTS: Group 2 showed significantly higher age, blood pressure, AVC, and MVC and significantly lower hemoglobin, sclerostin, and Dkk-1 levels. LVM and LVMI had a significant linear negative correlation to both serum sclerostin and Dkk-1 (r = -0.329 and -0.257, P=0.01 and 0.046 for LVM; r = -0.427 and -0.324, P=0.001 and 0.012 for LVMI, resp.). Serum Dkk-1 was an independent negative indicator for LVM and LVMI in multiple regression analyses (P=0.003 and 0.041 with 95% CI = -0.963 to -0.204 and -0.478 to -0.010, resp.). CONCLUSION: Serum sclerostin and Dkk-1 were significantly lower in HD patients with increased LVMI > 125 gm/m2, and both had a significant linear negative correlation with LVM and LVMI. Dkk-1 was a significant negative independent indicator for LVM and LVMI in HD patients.

Impact of malnutrition on health-related quality of life in patients on maintenance hemodialysis.

Malnutrition is considered as one of the most important risk factors that adversely affect the quality of life (QOL) in maintenance hemodialysis (MHD) patients. Many clinically useful nutrition assessment techniques are now available, but the usefulness of such techniques in predicting QOL in MHD patients had not been sufficiently tested. The aim of this study was to explore the relation between different nutritional assessment methods, and QOL and identify nutritional parameter that can best predict physical and mental domains of QOL in MHD patients. This cross-sectional study involved 84 MHD patients. Nutritional status was assessed by using International Society of Renal Nutrition and Metabolism criteria for diagnosis of protein-energy wasting (PEW), malnutrition inflammation score (MIS), subjective global assessment (SGA), anthropometric measurements, bioelectrical impedance analysis, and biochemical tests. Quality of life was evaluated by using the Kidney Disease Quality of Life (36 KDQOL-36). Only mental health composite component of QOL (MHC) showed statistically significant differences between PEW and non-PEW groups. MHC was correlated with serum albumin, MIS, and SGA. Physical health composite component (PHC) was correlated with age, hemodialysis duration, socioeconomic status, comorbidity, educational level, serum creatinine and ferritin, MIS, and SGA. On multiple linear regression analysis, MIS was found to be the most significant predictor of PHC while none of the nutritional parameters can predict MHC. Malnutrition is not uncommon problem in MHD patients that is associated with poor QOL. There are multiple factors associated with PHC and only malnutrition afflicts MHC in those patients.

Relation of protein energy wasting to carotid intima media thickness in hemodialysis patients.

Carotid intima media thickness (CIMT) can reflect the degree of atherosclerosis and cardiovascular risk in hemodialysis patients. Factors such as advanced age, male gender, family history, and smoking can increase the risk of CIMT. In hemodialysis (HD) patients, lower serum albumin level was found to be correlated with higher CIMT. This study aimed to evaluate the relation between CIMT and protein energy wasting (PEW) diagnosed according to the diagnostic criteria of International Society of Renal Nutrition and Metabolism (ISRNM) expert panel in HD patients. This study involved 45 HD patients who were divided into two groups according to the diagnostic criteria for PEW proposed by the ISRNM expert panel including group with PEW (11 patients) and group without PEW (34 patients). Caloric intake was evaluated by food frequency questionnaire for 3 days. Subjective global assessment (SGA) and malnutrition inflammation score (MIS) were fulfilled. Anthropometric measurements, as well as body composition, was evaluated by electrical bioimpedance analysis. Doppler ultrasonography was used to assess CIMT that was significantly higher in patients with PEW (p = 0.030). CIMT had significant positive correlation to age, SGA, and MIS (p = 0.008, 0.002, and 0.003, respectively). Significant negative correlation was observed between CIMT and serum albumin. Multiple linear regression analysis revealed that serum albumin was the only predictor of mean CIMT. In conclusion, CIMT seems to be related to malnutrition in HD patients. Low serum albumin was the only predictor of CIMT.

Relation Between Health-Care Medical Provider Opinion and Hemodialysis Patient Attitude Toward Fasting in Ramadan.

INTRODUCTION: Muslim hemodialysis (HD) patients are motivated to practice fasting in Ramadan. Health-care providers may be unable to make a recommendation based on lack of evidence. The aim of the present study was to investigate patients' and medical professionals' opinion toward fasting in 4 HD centers in Egypt as well as the impact of physicians' attitude on their patient behavior. MATERIALS AND METHODS: This observational multicentric study was conducted on 161 patients undergoing HD and 23 physicians in 4 HD centers in Egypt just after Ramadan 1438 Hijri. Patients' demographic characteristics as well as any associated comorbidities were recorded. Patients and physician were interviewed and were asked about their opinion toward fasting in HD patients and any experienced complications during fasting. RESULTS: Eighty-one (50.3%) patients of the studied HD patients practiced fasting in Ramadan. No statistical difference was observed between fasting and nonfasting groups regarding age, gender, and duration of HD. Eighty percent of patients reported no complications. Fifteen (65.2%) physicians support the opinion that HD patients are capable to fast with precautions. There was a significant variation in fasting frequency among HD patients in the studied centers with a significantly low fasting frequency observed in the third center (10.5%). Most physicians from this HD center adopted that HD patients should not fast. CONCLUSION: HD patients were keen to practice fasting in Ramadan and were to a considerable extent capable of completing this Islamic worship. Patient decision seems to be affected by their physician's opinion. Absence of clear recommendations to guide fasting in Ramadan in HD patients as in diabetic patients makes permission or prohibition of such practice unjustified.

Association between Serum Dickkopf-1 (DKK-1) Glycoprotein and Calcific Deposits on Cardiac Valves and Carotid Intimal-Medial Thickness in Hemodialysis Patients.

BACKGROUND: Cardiac valve calcification (CVC) is common in hemodialysis (HD) patients, and associated with cardiovascular and all-cause mortality. Once believed to be a passive process, it is now understood that the Wnt signaling pathway has a major role. The aim of the current study was to assess the relationship between circulating DKK-1, a negative regulator of the Wnt signaling pathway, and CVC, as well as carotid intimal-medial thickness (CIMT) in HD patients. METHODS: We enrolled 74 consecutive adults on maintenance HD. Echocardiographic calcification of the mitral valve (MV) and aortic valve (AV) were detected according to Wilkins score (range 0-4), and the study of Tenenbaum et al. [Int J Cardiol. 2004 Mar;94(1):7-13] (range 0-4), respectively. CVC severity was calculated by a supposed score (range 0-8) that represents the sum of calcification grade of MV and AV. CVC severity was classified into absent (CVC score = 0), mild (CVC score = 1-2), moderate (CVC score = 3-4), and severe (CVC score ≥5). Demographic and biochemical data were collected in addition to serum DKK-1 levels and CIMT. RESULTS: CVC was present in 67 patients (91.0%). There was a highly significant negative correlation between serum DKK-1 level and CVC score (r = -0.492; p ≤ 0.001), as well as CIMT (r = -0.611; p ≤ 0.001). Age and CIMT were independent determinants of CVC. CONCLUSIONS: CVC is almost present in all HD patients. DKK-1 seems to have a direct relation with CVC and CIMT in HD patients. Age is the strongest independent determinant of CVC.

Impact of Subtotal Parathyroidectomy on Clinical Parameters and Quality of Life in Hemodialysis Patients with Secondary Hyperparathyroidism.

BACKGROUND: Impairment of quality of life (QOL) is a key clinical characteristic of patients with end-stage renal disease (ESRD), and can be especially severe in the presence of secondary hyperparathyroidism (SHPT). Despite the proven success of parathyroidectomy (PTX) in controlling biochemical parameters in patients with severe SHPT, evidence is lacking regarding the effects of PTX on various clinical outcomes, including QOL. METHODS: Twenty ESRD patients on maintenance hemodialysis with SHPT who underwent subtotal PTX were included in an observational longitudinal study. All studied patients underwent history-taking, clinical examinations, and laboratory investigations, including a complete blood count and measurements of serum calcium, phosphorus, magnesium, parathyroid hormone (PTH), and albumin levels preoperatively and at 3 months postoperatively. QOL was assessed before surgery and at 3 months after surgery using the Kidney Disease Quality of Life 36-Item Short-Form instrument. RESULTS: After PTX, significant decreases in serum PTH and phosphorus levels were observed, as well as a significant increase in serum magnesium levels. Significant weight gain and improvements of QOL were also detected postoperatively. CONCLUSION: Subtotal PTX seems to be an efficient alternative to medical management in uncontrolled cases of SHPT, as it is capable of controlling the biochemical derangements that occur in hyperparathyroidism. Furthermore, PTX had a beneficial effect on clinical outcomes, as shown by weight gain and improvements in all QOL scales.

Virulence Factors Of Carbapenem-Resistant Pseudomonas aeruginosa In Hospital-Acquired Infections In Mansoura, Egypt.

PURPOSE: The problem of carbapenem-resistant Pseudomonas aeruginosa in health-care settings is growing worse. This study was conducted to investigate the rate of carbapenemase genes, antibiotic resistance, and virulence factors in carbapenem-resistant P. aeruginosa associated with hospital-acquired infections. PATIENTS AND METHODS: Isolates of P. aeruginosa were collected from patients with hospital-acquired infections at Mansoura University Hospital in Mansoura. Carbapenem susceptibility was done by broth dilution. The presence of carbapenemase genes and quorum-sensing genes was assessed by PCR. Production of protease, pyocyanin, twitching motility, hemolytic activity and biofilm formation was evaluated. RESULTS: Out of 80 P. aeruginosa isolates, 34 (42.5%) were resistant to carbapenem. Among carbapenem-resistant P. aeruginosa isolates, 21 (61.8%) were carbapenemase producers. The most prevalent gene detected was blaVIM. The frequency of protease, pyocyanin, twitching motility, hemolytic activity and biofilm formation was 76.2%, 58.8%, 83.8%, 93.8% and 77.5%, respectively. Biofilm formation was significantly associated with carbapenem-resistant P. aeruginosa. On the other hand, pyocyanin production was significantly lower in carbapenem-resistant isolates. No correlation existed between carbapenem resistance and any other studied virulence factors or quorum-sensing genes. CONCLUSION: Association of carbapenem-resistant P. aeruginosa with other antibiotic resistance or the presence of virulence factors in hospital-acquired infection may represent a warning that enhances the need for a stringent surveillance program.

Kidney Injury Molecule 1 (KIM-1) as an Early Predictor for Acute Kidney Injury in Post-Cardiopulmonary Bypass (CPB) in Open Heart Surgery Patients.

INTRODUCTION: Postoperative acute kidney injury is associated with a higher mortality, a more complicated hospital course with longer hospital stay. Urinary kidney injury molecule 1 may play an important role as an early predictor of acute kidney injury post-cardiopulmonary in open heart surgery. METHODS: We evaluated 45 patients who underwent open heart surgery from January 2016 to June 2016. Both urinary kidney injury molecule 1 and serum creatinine were evaluated before operation and 3hs and 24hs after operation. Acute kidney injury was diagnosed according to Kidney Disease: Improving Global Outcomes, 2012 guidelines. RESULTS: In this study, 27 patients developed acute kidney injury. The three hour-post-surgery urinary kidney injury molecule 1 was significantly higher in the acute kidney injury group (P<0.015) and, at the same time, we did not find any significant difference in the serum creatinine levels between the two groups. CONCLUSION: Although serum creatinine is still the gold standard for diagnosis of acute kidney injury searching for other new markers is mandatory. Urinary kidney injury molecule 1 can be used as simple noninvasive and specific biomarker for early diagnosis of acute kidney injury.

Status of fasting in Ramadan of chronic hemodialysis patients all over Egypt: A multicenter observational study.

There is a paucity of data concerning safety of fasting in Ramadan in chronic kidney disease patients on hemodialysis (HD). The aim of the present study was to assess the frequency of fasting in Ramadan in HD patients in Egypt and the possible effect of fasting on clinical and biochemical variables. This observational multicentric study was carried out during 2016 when fasting duration was around 16 h.

Hypervirulent Klebsiella pneumoniae as a hospital-acquired pathogen in the intensive care unit in Mansoura, Egypt.

INTRODUCTION: Hypervirulent Klebsiella pneumoniae (hvKP) are variants of K. pneumoniae that come up worldwide. hvKP is known in community-acquired infections but little is known about its role in hospital-acquired (HA) infections. The aim of this study was to evaluate the frequency of hvKP among HA K. pneumoniae infections in the intensive care unit (ICU) and to compare virulence and antibiotic susceptibility between hvKP and classical K. pneumoniae (cKP). METHODS: String test, biofilm formation, serum bactericidal assay, capsular polysaccharide genes (K1, K2, K5, K20, K54, K57), virulence genes: rmpA, rmpA2, iucA, iroB and antimicrobial susceptibility were assessed in HA K. pneumoniae strains isolated from the ICU in Mansoura, Egypt. RESULTS: Probable hvKP represented 4 out of 65 (6.2%) K. pneumoniae. K1 and K2 genes were present in 2 and 1 isolate respectively in probable hvKP. rmpA genes were significantly associated with hvKP; at the same time biofilm production and serum resistance were not significantly associated with the hypervirulent group. There was no significant difference between hvKP and cKP strains in terms of resistance pattern. CONCLUSION: hvKP in critically ill patients from the ICU may form a new threat especially in the presence of antibiotic resistance. Although the validity of the string test in detecting metastatic Klebsiella is questionable, it is a simple and easy test that can be done in any laboratory indicating the presence of this organism. Serotypes and genomic background may provide helpful and confirmatory tools to diagnose hvKP.

Obesity may be erythropoietin dose-saving in hemodialysis patients.

BACKGROUND: In dialysis patients, the obesity-survival paradox still requires an explanation. Anemia and high doses of erythropoiesis-stimulating agents (ESAs) are associated with worse outcomes in the hemodialysis (HD) population. In the present study, we explored the relation between obesity and anemia control in a sample of maintenance HD patients in Egypt. METHODS: This multicenter observational study included 733 patients on maintenance HD from 9 hemodialysis centers in Egypt. Clinical and laboratory data as well as average doses of ESAs and parenteral iron were recorded. The erythropoietin resistance index (ERI) was calculated. RESULTS: Obesity, defined as a body mass index (BMI) ≥ 30 kg/m2, was present in 22.6% of the studied population. The target hemoglobin level (10.0-11.5 g/dL) was achieved in 27.3% of non-obese and 25.3% of obese patients, with no significant difference. The median serum ferritin and the values of transferrin saturation index did not differ significantly between these two groups. The weekly ESA dose was significantly lower in obese than in non-obese patients (P = 0.0001). A trend toward higher ESA doses and ERI values was observed in patients with lower BMIs (P < 0.0001). Multiple linear regression revealed that the BMI and urea reduction ratio were the strongest predictors of the ERI. CONCLUSION: Our study adds more evidence to obesity-associated advantages in HD patients. BMI may determine ESA response, with better responses observed in patients with higher BMIs.

High level aminoglycoside resistant enterococci in hospital-acquired urinary tract infections in Mansoura, Egypt.

INTRODUCTION: Resistance to different antimicrobial agents is increasing in enterococci and effective treatment represents a major health concern. The aim of this study was to determine the antimicrobial resistance patterns and the frequency of high level aminoglycoside resistance (HLAR) among enterococci. METHODS: A total of 80 enterococcal isolates, (73 Enterococcus faecalis, 7 Enterococcus faecium) were collected from patients with hospital acquired urinary tract infections (UTI) at Mansoura University hospitals in Egypt. Antimicrobial susceptibility testing was performed via the disc diffusion method. PCR was used for identification of species and detection of aminoglycoside-modifying enzymes genes (AME). RESULTS: All enterococcal isolates were sensitive to vancomycin and linezolid. Fifty-three isolates exhibited HLAR. Our results show that HLAR was mediated by the presence of multiple AMEs genes. The aac(6')-Ie-aph(2')-Ia gene was associated with aph(3')-IIIa and ant(6)-Ia gene in 69% of HLAR isolates. CONCLUSION: This study showed that enterococci isolated from hospital acquired UTI were resistant to multiple antibiotics. Furthermore, the frequency of high level gentamicin resistance (HLGR) was higher than high level of streptomycin resistance (HLSR). The most common AME genes were aph(3')-IIIa and ant(6)-Ia followed by aac(6')-Ie-aph(2')-Ia.

Persistent oxidative stress in patients with chronic active hepatitis-C infection after antiviral therapy failure.

BACKGROUND/AIMS: Oxidative stress and hepatocellular pathological changes are common associations with chronic hepatitis C virus (CHC) disease. The aim of this study was to assess serum antioxidant-oxidant (Redox) balance in patients with CHC infection before and after intake of the traditional antiviral therapy (pegylated interferon α-2b and oral ribavirin). PATIENTS AND METHODS: Blood samples from 50 biopsy-proven CHC patients, with no prior anti-viral treatment and persistently elevated serum transaminase levels for 6 months, as well as 15 age- and sex-matched healthy subjects were used for determination of the antioxidants: reduced glutathione (GSH), superoxide dismutase (SOD), α tocopherol and ascorbic acid as well as lipid peroxidation (LPO) index (malondialdehyde [MDA]). The measurements were repeated in the diseased group 25 weeks after pegylated interferon α-2b and ribavirin combination therapy. RESULTS: Serum levels of bilirubin, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were significantly higher in CHC patients than in the control group (P < 0.05). Pretreatment serum MDA values were significantly higher in patients with CHC infection than the control group (P < 0.001), while serum antioxidant levels were significantly lower (P < 0.001). Responders (10 patients) had lower pretreatment serum levels of MDA than non-responders (35 patients) (P < 0.001). Both groups were comparable for the antioxidant serum levels. There was significant negative correlation between serum MDA and serum SOD, GSH, α tocopherol, and ascorbic acid concentrations in CHC patients. On the other hand, there was no correlation between the studied parameters and serum bilirubin, albumin, ALT, and AST. CONCLUSIONS: Redox imbalance was detected in patients with CHC. Responders had significantly lower levels of MDA than non-responders. Serum MDA may be used as a pretreatment predictor of response to antiviral treatment in patients with CHC.