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Background The neutrophil–lymphocyte ratio (NLR) and monocyte–lymphocyte ratio (MLR) in the peripheral blood are used as indicators of systemic inflammation and predictors of cardiovascular (CV) diseases. Aims To study the relation between both NLR and MLR and the prediction of cardiovascular events (CVE) in end-stage renal disease (ESRD) patients on regular hemodialysis. Patients and methods In all, 70 ESRD patients on regular hemodialysis were followed up for 12 months. NLR, MLR, and their individual components were determined at baseline and in the follow-up months. The changes in NLR and MLR after 12 months were compared. High-sensitivity C-reactive protein and echocardiography studies were done at baseline and after 12 months. Major CVE were recorded. Results Total leukocyte, absolute neutrophil, and monocyte counts were significantly increased over time. The presence of valvular calcification was associated with an increase in both NLR and MLR (P=0.004 and 0.001, respectively) after 12 months. The mean monocyte counts were significantly higher in patients with CV complications. The baseline monocyte count was the best to predict CV complications with a cutoff point more than 0.54 × 103/µl (sensitivity 100%, specificity 73.85%) in the receiver-operating characteristic curve. Conclusion In ESRD patients, leukocyte counts are in a dynamic change. There was no significant change in NLR or MLR over time and their changes could not predict the occurrence of CVE. The monocyte count is an excellent predictor of CV diseases. The presence of valvular calcification is associated with increases in both NLR and MLR over time. [ABSTRACT FROM AUTHOR]

Introduction: Hepatitis C virus (HCV) infection is strongly associated with chronic kidney disease (CKD). It is an independent risk factor for developing CKD and significantly increases morbidity and mortality in CKD patients. Treatment with newer direct-acting antiviral (DAA) regimens in patients with CKD is showing conflicting results as regards safety and efficacy. Objectives: To evaluate the safety and efficacy of DAAs and their impact on kidney function in CKD patients. Patients and Methods: We conducted a prospective observational study on 100 CKD patients stages 3-4, receiving treatment for HCV at MASRI (Faculty of Medicine Ain Shams University Research Institute), with two different DAAs regimens (sofosbuvir/daclatasvir with or without ribavirin and ombitasvir/paritaprevir/ritonavir [OMV/PTV/RTV] with ribavirin), completed over six months follow up. Serum creatinine, estimated glomerular filtration rate (eGFR), and proteinuria were followed during and after treatment. Results: Sustained virological response (SVR) was achieved in all patients. Improvement of eGFR (8-15 mL/min/1.73 m2) and proteinuria was found in both study groups. Acute kidney injury (AKI) was uncommon; it occurred in three (3%) patients, out of them, two patients showed complete recovery. Adverse events were common (43%), but serious adverse events were uncommon (2%). Conclusion: DAA regimens were effective and well-tolerated for HCV infected patients with stage 3-4 CKD, where viral clearance caused improvement in eGFR and proteinuria. [ABSTRACT FROM AUTHOR]

Background: Anemia is a severe complication of chronic kidney disease (CKD) that is seen in more than 80% of patients with impaired renal function. Although there are many mechanisms involved in the pathogenesis of anemia of renal disease, the primary cause is the inadequate production of erythropoietin by the damaged kidneys. Aim of the work: to assess hepcidin level in non dialysis patients (CKD stage 4 &5) treated from Hepatitis C virus and its relation to iron parameters. Patients and Methods: This study was conducted on 20 CKD patients (stage 4 and 5) treated from hepatitis C virus. All candi- dates included in this study subjected to careful history taking, full clinical examination and investigations (including complete blood count, renal chemistry, HCVAb, serum iron, total iron binding capacity, TSAT%, ferritin and hsCRP. Serum hepcidin was analyzed by ELISA technique. Results: Serum hepcidin was 26.3567.26; 40% in stage III, 37.8% in stage IV and 22.2% in stage V. There was statistically significant difference between GFR stages according to Hb., Drug intake ACE inhibitor/ARB, Plt., Creatinine, BUN, Iron, TIBC, Ferritin, T SAT%, CRP and Serum Hepcidin. We showed significant correlations between serum hepcidin and TIC, Iron, TIBC, Ferritin and TSAT%. Conclusion: Median hepcidin value is elevated in nondialysis CKD patients due to increased inflammation and decreased clearance of hepcidin. Furthermore, iron status modifies serum hepcidin level and its association with Hb. Increased hepcidin level leads to iron-restricted erythropoiesis and recombinant human EPO (rhEPO) resistance by inhibiting iron absorption from gut and iron recycling from macrophages. Hence, elevated hepcidin can predict need for parenteral iron to overcome hepcidin-mediated iron-restricted erythropoiesis and need for relatively higher rhEPO doses to suppress hepcidin. [ABSTRACT FROM AUTHOR]

Background: The etiology of anemia in End Stage Renal Disease is multifactorial. Importantly, ESRD patients also have several abnormalities in systemic homeostasis of iron, an essential component in the production of red blood cells. Aim of the Work: to assess hepcidin level in negative virology End Stage Renal Disease patients & its relation to iron level and erythropoiesis. Patients and Methods: This study was conducted on 45 patients who are stage V chronic kidney disease on regular haemodialysis. Ten age and sex matched controls were included in the study. The study included 29 (64.4%) males and 16 (35.6%) females; their mean age was 53.40611.56 years. The prevalence of diabetes among the studied cases was 17.8%, while that of hypertensive was 42.2%. Mean of serum iron level was 64.23619.53. Mean of TIBC was 409.96667.85. Mean of Ferritin level 394.556139.23 and mean of Hepcidin level was 218.516127. Results: Significant negative correlation between Hepcidin level and the Hemoglobin level, and highly significant positive correlation between Hepcidin level and serum Ferritin. Hepcidin up-regulation in the setting of CKD, with subsequent increased serum levels, results in impaired iron absorption from the intestine and decreased iron release from body storage sites. Ultimately, in the setting of such elevated levels, a state of functional iron deficiency may develop and lead to anemia due to iron-restricted erythropoiesis. Conclusion: Based on current evidence, it seems likely that hep- cidin represents a potentially modifiable mediator of anemia of CKD and is thus a potential target for future anemia therapy. [ABSTRACT FROM AUTHOR]

Background: Volume overload is considered as an important clinical problem in end stage renal disease patients. It is associated with morbid situations such as pulmonary hypertension and lung congestion. Aim of the Work: to assess the effect of increased the patient weight between haemodialysis sessions that is known as interdialytic weight gain (IDWG) on pulmonary hypertension using Echocardiography (Echo) and lung congestion using lung ultrasound (LUS) in two groups: First group with IDWG < 3.5% of their dry weight while Second group with IDWG > 3.5% of their dry weight, compare between the two groups and to detect statistically the effects of IDWG & ultrafiltration on PAP and lung congestion. Patients and Methods: This observational cross sectional study was conducted at on 60 patients who have end stage kidney disease &are currently on haemodialysis at Nasser Institute Hospital: 30 patients with an IDWG < 3.5% and 30 patients with an IDWG > 3.5% of their dry weight. Pulmonary artery pressure was measured by echo and patients classified according to PAP into mild, moderate and severe pulmonary hypertension. Lung congestion in all patients was measured by lung ultrasound and patients classified into minimal, mild, moderate and severe lung congestion. Results: Our study showed that pulmonary hypertension prevalence was 30% while lung congestion was 100%. pulmonary hypertension pathophysiology includes acute and chronic processes and HD therapy alone is not effective in complete treatment of pulmonary hypertension and require medical treatment. Patients with increased IDWG > 3.5% (group 2) had pre HD higher PAP than those with IDWG < 3.5% (group 1) and patients with IDWG > 3.5% had more change in their PAP post HD session than those with IDWG < 3.5% but no significant difference between the change after the HD session in both groups. HD duration is an important factor in PH development over years. There is a significant relation anemia and hypercalcemia with PH. Patients with more increased IDWG > 3.5% (group 2) had higher pulmonary congestion than those with IDWG < 3.5% (group 1) and patients with IDWG < 3.5% had more change in their lung congestion level after the HD session than those with IDWG > 3.5% but no statistical significance between the change in both groups. There was a significant relation between HD therapy duration with pulmonary congestion measured prior to the session.Conclusion: on the short term increased IDWG% affect lung congestion more than pulmonary hypertension. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to detect, prospectively, the effect of 3 months dialysis with Hemodiafiltration on inflammatory and nutritional biomarkers in comparison to conventional dialysis with high flux dialyzer in stable HD patients. Patients and methods: 30 adults aged 20-75 years who were selected from Dialysis Unit, Kobary El-Kobba Military Hospital. 30 male patients known to have chronic kidney disease and are on dialysis with high flux dialyzer more than 3 months were divided into 2 groups:15 Patients are shifted to be on dialysis with HDF and 15 Patients are continued to be on Regular Hemodialysis with high flux dialyzer. Full medical history and clinical examination. Anthropometric measurements and Laboratory investigations including Complete Blood Picture (WBCs, platelets, Hb), Coagulation profile PT, PTT&INR, Liver function tests (ALT, AST, T. Bilirubin and S. Albumin), Lipid pro- file (Triglycerides, total cholesterol, VLDL), S. creatinine, BUN, Na, K, Uric acid, Total Proteins, Serum Calcium, Serum Phosphorus, PTH, Serum ferritin, High sensitivity CRP (Enzyme- Linked Immunosorbent Assay (ELISA)) and IL6 (ELISA). Results: The current study was conducted on 30 patients with chronic kidney disease on regular dialysis. The patients were divided into two groups A representing patients on hemodiafil- tration (n =15) and group B representing patients on dialysis with high flux dialyzer (n =15). A high statistical significant difference (P <0.01) was found regarding K 4.360.6 meq/l in group A while it is 5.260.5 meq/l in group B, a high statistical signifi- cant difference (P <0.01) was found regarding phosphorus 4.661.0 mg/dl in group A while it is 6.160.9 mg/dl in group B and no statistical significant difference (P >0.05) was found as regard the uric acid. A statistical significant difference (P <0.05) was found regarding CRP 63.5640.9 mg/dl in group A while it is 73.4633.2 mg/dl in group B, a statistical significant difference (P <0.01) was found regarding IL6 85.3637.6 mg/dl in group A while it is 156.76151.9 mg/dl in group B after 3 months and no statistical significant difference (P >0.05) was found as regard those inflammatory markers before 3 months. A statistical significant difference (P <0.05) was found regarding CRP. A statistical significant difference (P <0.05) was found regarding IL6. Conclusion: The present study revealed that there was no significant change in CRP and IL6 in patients on HDF compared to patients undergoing hemodialysis with high flux dialyzer before 3 months but there was a significant decrease in CRP and IL6 in patients on HDF compared to patients undergoing hemodialysis with high flux dialyzer after 3 months. [ABSTRACT FROM AUTHOR]

Introduction: Despite the significant link between HCV and CKD progression, most of the patients with CKD infected with HCV remain untreated, because they have historically been difficult to treat due to common adverse effects associated with inter- feron (IFN), ribavirin, and first generation protease inhibitors. Recently, there have been major advancements in the treatment of HCV with the development of new directacting antivirals (DAAs). Objectives: To evaluate the safety and efficacy of DAAs and their impact on kidney function in CKD patients. Patients and Methods: We conducted a prospective observatio- nal study on 100 CKD patients stages 3-4, receiving treatment for HCV at MASRI (faculty of Medicine Ain Shams University Research Institute), with two different DAAs regimens, com- pleted over six months follow up. Kidney function was followed during and after treatment. Results: Sustained virological response (SVR) was achieved in all patients. AKI (acute kidney injury) was uncommon; it occurred in three (3%) patients, out of them, two patients showed complete recovery. Adverse events were common (43%), but serious adverse events were uncommon (2%). Improvement of eGFR (8-15 ml/min/1.73 m²) and proteinuria was found in both study groups. Conclusion: DAAs were effective and welltolerated for HCV infected patients with stage 3-4 chronic kidney disease, where viral clearance caused improvement in eGFR and proteinuria. [ABSTRACT FROM AUTHOR]

Background: Anemia is a severe complication of chronic kidney disease (CKD) that is seen in more than 80% of patients with impaired renal function. Hepcidin, an acute phase reactant protein produced in the liver, is a key regulator of iron homeostasis. Aim of the Work: to assess hepcidin level in 45 non-dialysis patients (CKD stage IV and V with negative virology) and its relation to iron parameters. Patients and Methods: A cross sectional study was conducted at Nasser Institute for Treatment and Research on 45 patients with chronic kidney disease stage IV and V. All patients included in this study were subjected to the following: Careful history taking, full clinical examination and proper laboratory investigations. Results: A statistically significant difference was found between CKD stage 4 and stage 5 according to Hb., iron, TIBC, Frerretin, serum and CRP. Also, there was a significant positive correlation of serum hepcidin with serum ferretin and hsCRP, while Hb and iron were significantly negatively correlated with hepcidin. We found statistically significant decrease in Hb level, serum Iron level, and TIBC in CKD stage 5 less than stage 4. We found statistically significant increase in Hepcidin level, serum ferritin, and hsCRP in CKD stage 5 more than stage 4. We found statistically significant Positive correlation between serum hepcidin with serum ferretin among patients with CKD stage 4 and 5. We found statistically significant Positive correlation between serum hepcidin with hsCRP among patients with CKD stage 4 and 5. We found statistically significant negative correlation between serum hepcidin with Hb among patients with CKD stage 4 and 5. A statistically significant Positive correlation between serum hepcidin with serum Iron among patients with CKD stage 4 and 5. Also we reported a statistically non-significant negative correlation between serum hepcidin and TIBC. Conclusion: Elevated hepcidin can predict the need for parenteral iron to overcome hepcidin-mediated iron-restricted erythropoiesis and need for relatively higher rhEPO doses to suppress hepcidin in CKD patients with negative viral markers. [ABSTRACT FROM AUTHOR]

Background: Contrast-induced nephropathy (CIN), is an acute impairment in renal function, and typically occurs within 3 days following the exposure to a contrast medium (CM). It is associated with increased hospital stay and increased morbidity and mortality, Adult patients with diabetes have a higher risk than the general population for developing contrast induced nephropathy. Methods: The current study includes 40 patients with diabetes mellitus, scheduled for coronary angiography with estimated GFR >60 ml/min .the patients were divided according to their pre-procedural urinary albumin creatinine ratio (ACR) results into 3 groups: Group 1 included patients with pre-procedure urinary albumin creatinine ratio < 30mg/g, Group 2 included patients with pre- procedure albumin creatinine ratio 30- 300 mg/g and Group 3 included patients with pre-procedure albumin creatinine ratio >300 mg/g . Estimated GFR (glomerular filtration rate) calculated using MDRD and serum creatinine were measured at day 2 and 3 (Day +2 +3) after coronary angiography. Results: There was no statistically significant difference in the age and gender distribution, the use of ACEIs (angiotension converting enzyme inhibitors) or diuretics between the cases who developed and who didn’t develop CIN. The mean ACR in the group with no contrast induced nephropathy was 225.38 ± 209.53 which was statistically significantly lower when compared with the cases with contrast induced nephropathy (420.436 348.52) (p=0.033). The mean HbA1c in no contrast induced nephropathy group was 7.11 ± 0.64 and in contrast induced nephropathy group it was 9.09 ± 0.66 which is significantly higher (P>0.001).With univariate regression analysis, ACR, HbA1c and number of vessels affected were shown to be risk factors for occurrence of CIN after use of contrast, but with multivariate analysis, both ACR and HbA1c were shown to be risk factors for CIN. Conclusion: An increase in albumin creatinine ratio in itself can be a risk factor for development of contrast induced nephropathy in diabetic patients. [ABSTRACT FROM AUTHOR]

Background: Assessment of access recirculation (AR) is crucial to dialysis efficiency and there is thus a need for a method yielding a highly accurate, fast, easy and economical measurement that can be applied in any dialysis clinic. Non-urea based dilutional methods are more accurate than urea based methods and avoid problems with cardiopulmonary recirculation, but they require expensive specialized devices, which limit their applicability. Patients and Methods: We used simple dilutional method of AR based on the determination of serum potassium [K+] in two samples. A prospective study was performed in a Dialysis Unit at El Sahel Teaching hospital, Cairo, on End stage kidney disease patients on regular Hemodialysis through a functioning Arterio-venous fistula. Results: Access recirculation was found in 42% of studied patients. There were Highly Significant positive correlation between access recirculation, pre / post dialysis blood urea, basal k, and parathyroid hormone level. In addition, there were highly significant negative correlation between AR, Urea reduction ratio and KT/V. Conclusion and Recommendations: Potassium dilution method is one of the most simple, specific, and economical way to measure access recirculation and can easily be performed in any dialysis unit. We recommend more research should be done about hemodialysis adequacy, access recirculation and how to improve it. [ABSTRACT FROM AUTHOR]

Background: Assessment of access recirculation (AR) is crucial to dialysis efficiency and there is thus a need for a method yielding a highly accurate, fast, easy and economical measurement that can be applied in any dialysis clinic. Non-urea based dilutional methods are more accurate than urea based methods and avoid problems with cardiopulmonary recirculation, but they require expensive specialized devices, which limit their applicability. Patients and Methods: We used simple dilutional method of AR based on the determination of serum potassium [K+] in two samples. A prospective study was performed in a Dialysis Unit at El Sahel Teaching hospital, Cairo, on End stage kidney disease patients on regular Hemodialysis through a functioning Arterio-venous fistula. Results: Access recirculation was found in 42% of studied patients. There were Highly Significant positive correlation between access recirculation, pre / post dialysis blood urea, basal k, and parathyroid hormone level. In addition, there were highly significant negative correlation between AR, Urea reduction ratio and KT/V. Conclusion and Recommendations: Potassium dilution method is one of the most simple, specific, and economical way to measure access recirculation and can easily be performed in any dialysis unit. We recommend more research should be done about hemodialysis adequacy, access recirculation and how to improve it. [ABSTRACT FROM AUTHOR]

Background: Patients with end stage renal disease on regular hemodialysis (HD) commonly present with volume overload. This has been found to be associated with increased incidence of pulmonary hypertension (PH) and chronic lung congestion. Objective: The aim of the study was to determine the effect of interdialytic weight gain (IDWG) on pulmonary artery pressure by echocardiography and lung congestion by lung ultrasound. Patients and Methods: This observational cross-sectional study was conducted on 60 patients on regular haemodialysis at Nasser Institute Hospital, Cairo. Patients were divided into 2 groups: Group (I) 30 patients with IDWG < 3.5% of their dry weight, and Group (II) 30 patients with IDWG > 3.5 % of their dry weight. Results: Patients with increased IDWG > 3.5% (group 2) had pre-HD higher pulmonary artery pressure (PAP) than those with IDWG < 3.5% (group 1) and patients with IDWG > 3.5% had more change in their PAP post HD session than those with IDWG < 3.5% but no significant difference between the change after the HD session in both groups. There is a significant relation between HD duration, anemia, and hypercalcemia with PH. Patients with more increased IDWG > 3.5 % (group 2) had higher pulmonary congestion than those with IDWG < 3.5% (group 1) and patients with IDWG < 3.5% had more change in their lung congestion level after the HD session than those with IDWG > 3.5% but no statistical significance between the change in both groups. Conclusion: Increase in IDWG% over 3.5% significantly affects lung congestion and pulmonary hypertension in dialysis patients. [ABSTRACT FROM AUTHOR]

Background: Contrast-induced nephropathy (CIN), is an acute impairment in renal function, and typically occurs within 3 days following the exposure to a iodinated contrast medium (CM). It is associated with increased hospital stay and increased morbidity and mortality. Adult patients with diabetes have a higher risk than the general population for developing contrast-induced nephropathy. Objective: To assess the significance of preprocedural microalbuminuria on renal function changes post coronary angiography. Patients and methods: The current study included 40 patients all over the age of 18 years, with diabetes mellitus type 1 or type 2, scheduled for coronary angiography with estimated GFR > 60 ml/min. Results: incidence of contrast-induced nephropathy in this study was 40 % (n=16) of patients while 60% (n = 24) did not fit the definition of CIN. There was no statistically significant difference in the age, gender distribution and use of angiotension converting enzyme inhibitors (ACEIs) or diuretics between the cases who developed and who did not develop CIN. The mean albumin creatinine ratio (ACR) in the group with no contrast induced nephropathy was 225.38 ± 209.53 which was statistically significantly lower when compared to the cases with contrast-induced nephropathy (420.43 ± 348.52) (p = 0.033). The mean HbA1c in no contrast-induced nephropathy group was 7.11 ± 0.64 and in contrast induced nephropathy group it was 9.09 ± 0.66, which was significantly higher (P > 0.001). With univariate regression analysis, ACR, HbA1c and number of vessels affected were shown to be risk factors for occurrence of CIN after use of contrast, but with multivariate analysis, both ACR and HbA1c were shown to be risk factors for CIN. Conclusion: An increase in urinary albumin creatinine ratio in itself maybe be a risk factor for development of contrast-induced nephropathy in diabetic patients. [ABSTRACT FROM AUTHOR]