Epidemiology and risk factors of chronic kidney disease in the El-Sharkia Governorate, Egypt.

End-stage renal disease (ESRD) is increasing worldwide. Renal replacement therapy and kidney transplantation are increasing the burden on health systems. Various risk factors can lead to this disease. In this work, we tried to study the epidemiology and risk factors of chronic kidney diseases (CKDs) in one of the Egyptian areas (El-Sharkia Governorate), and from this study we can get some data about the distribution and most common causes of this disease. A cross-sectional study was conducted at 15 dialysis centers in governmental hospitals in ElSharkia, Egypt. We used a questionnaire and direct interviewing with ESRD patients in addition to using medical records for our data collections. One thousand and four patients were selected randomly from 2136 patients who were known CKD patients on regular hemodialysis. Each week, two to three visits were performed in each center and during each visit, direct interviews were performed for ten to 15 patients, which took about 30 min for each patient. The study sample (n = 1004 patients) consisted of 62.2% males and 37.8% females. The mean age of patients was 52.03 + 14.67 years. The highest percentage of patients (31.9%) was found to be between 50 and 60 years in both males and females. More than half (61.3%) of the ESRD patients were living in villages, while about one-third (38.7%) of the ESRD patients were living in cities. Hypertension and diabetes were the main causes of ESRD. 15.5% of ESRD patients had diabetes mellitus, 31.8% had hypertension, 8.4% had kidney stone, 8.8% had urinary tract infection, 4.6% had congenital abnormality and 3.7% had primary glomerulonephritis. The main risk factors of renal diseases are hypertension and diabetes, while unknown causes represent a high percentage of all causes by 17.7%. Primary glomerulonephritis is the lowest cause of CKD in the El-Sharkia governorate, Egypt.

Association of the receptor for advanced glycation end products (RAGE) -374 T/A gene polymorphism and circulating soluble RAGE with nephropathy in type 1 diabetic patients.

The binding of advanced glycation end-products (AGEs) to their receptor (RAGE) may play an important role in the development of diabetic vascular complications. Circulating soluble RAGE (sRAGE) reflects tissue RAGE expression. We examined circulating sRAGE and RAGE -374 T/A gene promoter polymorphism in type 1 diabetic patients and explored their possible associations with the development of nephropathy. Fifty diabetic patients with disease duration >10 years and 20 age, sex and body mass index (BMI) matched healthy controls were included in the study. Diabetic patients were subdivided into 23 patients without nephropathy and 27 with nephropathy. All the studied individuals were subjected to the following investigations: fasting glucose, HbA1c, serum creatinine, lipid profile, albuminuria and sRAGE levels. The -374 T/A RAGE gene polymorphism was studied by PCR amplification and restriction fragment length polymorphism (RFLP) analysis. Our study reported significant increase in sRAGE in diabetic patients compared to controls and in diabetic patients with nephropathy compared to those without nephropathy (P < 0.001). sRAGE was significantly correlated with HbA1c, creatinine, albuminuria and atherogenic lipid profile. There were significant increase in the frequency of RAGE -374 A allele (T/A and/or A/A genotypes) in diabetic patients with nephropathy compared to those without nephropathy and control groups (P < 0.01). A allele was a risk factor for diabetic nephropathy (OR 2.36 & 95% CI 1.1-5.6). RAGE -374 A allele was associated with increased sRAGE levels, hypertension and increased creatinine concentration in diabetic patients. This study points to the possible role of sRAGE as a marker of early nephropathy in diabetic patients. Early testing for the RAGE gene -374 T/A could have merit in predicting risk of diabetic nephropathy later in life.