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Jan 2020
Jalal Al Mosawi AamirCorresponding author
Children Teaching Hospital, Baghdad Medical City, Bab Al Muadham, Baghdad, Iraq
A new dietary approach used to lower urea levels in chronic renal failure, and thus simulating dialysis has been recently described. This approach has been increasingly called intestinal or dietary dialysis. The aim of this paper is to describe the emerging evidence, principles, and concepts related to intestinal dialysis.
Dec 2019 DOI 10.14302/issn.2574-4488.jna-19-3112
Aydin ZekiCorresponding author
Darica Farabi Training and Research Hospital, Department of Nephrology, Kocaeli, Turkey
Introduction Increased oxidative stress and blunted anti-oxidant mechanisms are important problems in hemodialysis (HD) patients. Reactive oxygen species (ROS) act directly on proteins, leading to the formation of oxidized amino acids. Advanced oxidation protein products (AOPP) are among these substances. Many oxidant substances increase the level of AOPP. Iron is an element with strong oxidant capacity, especially when used intravenously. It is thought that iron treatment further increases the oxidative stress in HD patients. We aimed to investigate the relationship between AOPP and inflammatory status in HD patients. Materials and Methods Patients who were on maintenance HD program without additional co-morbidities and no history of use of intravenous iron within the last two weeks were recruited in the study. The blood samples taken just before the dialysis session were analyzed for AOPP, serum iron, total iron binding capacity (TIBC), ferritin, C-reactive protein (CRP), ß2-microglobulin, fibrinogen, interleukin (IL)-1, IL-6 and tumor necrosis factor-α levels besides routine biochemical measurements and complete blood count. Results The number of patients included in the study was 102 (n: 53 female, %52.0) and the mean age was 47.6±13.9 years. The mean transferrin saturation was 25.4%. AOPP levels, iron use in patients was higher compared to patients who do not use (respectively 2.58±0.19 mmol/l and 2.50 ±0.16mmol/l, p = 0.046). We did not detect statistically significant correlation of AOPP levels with iron parameters and other inflammatory markers. Conclusion The present study showed that intravenous iron therapy does not increase oxidative stress. Although serum AOPP level was higher in patients on intravenous iron treatment, it was not correlated with iron indices and inflammatory markers. So, intravenous iron may exert its oxidant effect free from serum iron indices.
Feb 2018 DOI 10.14302/issn.3070-5835.jcpn-18-1956
Kara BelgüzarCorresponding author
Department of Internal Medicine Nursing, Faculty of Health Sciences, Yuksek Ihtisas University, Ankara, Turkey
This pilot study aimed to determine the knowledge, beliefs and attitudes of Turkishpatients on in-center hemodialysis about home hemodialysis (HHD) and their related factors. A cross-sectional study was performed among 32 patients on in-center hemodialysis in a tertiary hospital in Turkey. Data were collected by using a questionnaire form including sociodemographic and disease-related characteristics and knowledge, beliefs and attitudes about HHD. Data analysis were performed using descriptive statistics and the Chi-square test. While the majority of the patients (65.6%) reported having knowledge about HHD, only 34.4% of them had ever considered it. The most common perceived benefits of HHD were minimized wasted time (71.9%) and more time spent with family (71.9%). The most common perceived barrier to HHD was also housing constraints (90.6%). The results of this study highlight the importance of recognizing knowledge, beliefs and attitudes toward HHD in patients on in-center hemodialysis for increasing the use of the treatment.
Jun 2016 DOI 10.14302/issn.2329-9487.jhc-15-905
D. Raikou VaiaCorresponding author
Dpt of Medicine - Propaedaetic, National & Kapodistrian University of Athens, School of Medicine.
Backgroud: Metabolic acidosis, a common condition particularly in end stage renal disease patients, results in malnutrition and inflammation. In this study, we focused on the importance of metabolic acidosis on manifestations of cardiovascular disease in patients on peritoneal dialysis. Methods: We studied 20 patients on continuous ambulatory peritoneal dialysis (CAPD), 15 males and 5 females, on mean age 61.6 ±11.3 years old. Metabolic acidosis was determined by serum bicarbonate concentrations less than 22mmol/L, which were measured in gas machine. Dialysis adequacy was defined by total Kt/V/week for urea including peritoneal Kt/V for urea and residual GFR (ml/min/1.73m2). High sensitivity C-reactive protein (hsCRP) was measured using enzyme linked immunoabsorbed assay (ΕLISA). The concentrations of intact-parathormone (i-PTH) and beta2-microglobulin (beta2M) were measured by radioimmunoassays. Arterial stiffness was measured as carotid-femoral pulse wave velocity (c-f PWV) and augmentation index (AIx). We built a Cox regression analysis to predict coronary artery disease (CAD), congestive heart failure (CHF) and peripheral vascular disease (PVD). Results: Serum bicarbonate levels were inversely associated to beta2M, i-PTH and AIx (r=-0.451, p=0.04, r=-0.477, p=0.03 and r=-0.569, p=0.009 respectively). Cox- regression analysis revealed significant association of serum bicarbonate levels and PVD having as confounders traditional and specific for these patients risk factors. Conclusion: Metabolic acidosis may be an independent risk factor for arterial stiffening and peripheral vascular disease manifestation in patients on peritoneal dialysis.
May 2016 DOI 10.14302/issn.2574-4488.jna-15-720
El Bardai GhitaCorresponding author
Nephrology department, Hassan II University Hospital, Fez, Morocco.
Introduction: Sonographic B-lines, also known as lung comets, have been shown to correlate with the presence of extravascular lung water. The aim of this study is to assess if chest ultrasound could detect lung water imbibition and its variations induced by dialysis, an experimental model of controlled rapid fluid loss. Methods: A cross-sectional study was conducted in a hemodialysis center in the city of Fez. Lung ultrasounds, impedance measurement, and ultrasound of the inferior vena cava were achieved 30-60 minutes before and after the hemodialysis session. Results: The values, measured by the different techniques used, decrease significantly after hemodialysis (p <0.001). The values studied before and after the hemodialysis, had shown a significant correlation between the results of the impedance measurement, lung ultrasound, and the maximum and minimum of the VCI index diameter and its collapsibility. The decrease in B-lines was correlated with weight decrease during dialysis (p0.005); none of the parameters concerning the IVC were correlated with fluid removal. Conclusion: ultrasound performed at the bedside is now emerging as a reliable, easy-to-apply, and safe method for measuring both lung water and intravascular overload and their decrease after dialysis even on asymptomatic patients. These observations strongly support the use of lung ultrasound in estimating volume overload and monitoring the response to therapy in hemodialysis patients.
Feb 2016 DOI 10.14302/issn.2572-5424.jgm-15-815
Abd Elhamid SamahCorresponding author
Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University*, Cairo, Egypt
Background: Polymorphonuclear leucocytes are the first line of defence against foreign invaders and constitute the major cell type involved in certain types of acute and chronic inflammatory diseases. Aim of the Work: The aim of the present study was to investigate the changes in expression of BCL-2 and BAK genes by real time PCR and to study whether they were involved in the accelerated neutrophil apoptosis which might be responsible for the recurrent bacterial infections seen in chronic renal disease and hemodialysis patients. Subjects and Methods: This study was conducted on sixty two subjects. Patients were selected from those admitted to Theodor Bilharz Research Institute (TBRI). Patients under study were classified into three groups; CKD patients (group I) kept on conservative treatment (22 cases), ESRD patients (group II) maintained on dialysis therapy, HD (20 cases). In addition, twenty healthy individuals served as a control group (group III) were involved. Results: There was significant increase in level of BAK gene in both patients' groups compared to control group with more increase in CKD group than ESRD group. Significant difference between the 3 groups was encountered with a higher expression level in CKD and ESRD groups than controls. There was decrease in level of BCL2 gene in both groups less than control group with more declines in ESRD group than CKD group. Conclusion: Bcl2 and Bak genes could have a role in survival and apoptosis of the studied groups and suggested their impact in controlling the inflammatory mechanisms and eventually their therapeutic potential.
Jul 2020 DOI 10.14302/issn.2377-2549.jndc-20-3460
Tamilvanan NivedharshiniCorresponding author
India
Laccase enzyme production is important and more beneficial for environment, because it has many roles like, involved in bioremediation, biodegradation, decolorization of environmental polluted dyes and pharmaceutical sector also. Production of laacse enzyme from bacillus sp as using of Agro waste (rice bran) as a substrate. The Agricultural soil sample was collected, after the sample were processed for the preliminary and biochemical tests to identification of Bacillus organism. The Guiacol inducer were used for microbial screening of laccase enzyme production. After that microbial screening, various optimization parameters (pH, Temperature, Inducers, carbon and nitrogen sources) are checked for that production of laccase enzyme in mass level. Based on that optimization the bulk fermentation (large scale) (solid state fermentation) were done as a rice bran substrate. The fermentation product was subjected to analyzed the physiochemical properties and purification based on that techniques of Gel filtration chromatography, Dialysis, Ammonium sulfate preciptation. The protein estimation of that product to analysed by lowry’s method.
May 2020 DOI 10.14302/issn.2575-7881.jdrr-20-3343
Hussen Abdelrhman AmgedCorresponding author
Assis Professor, Department of Hematology and Immunohematology, Omdurman Islamic university / Sudan
Background Anemia of chronic disease is anemia found in certain chronic disease states, is typically marked by the disturbance of iron homeostasis or hypoferremia. Chronic renal failure is currently known as Chronic Kidney Disease (CKD) or Chronic Renal Insufficiency (CRI) implies long-standing, progressive and irreversible renal parenchyma disease resulting in diminished renal function up to 40 to 60%. Often, chronic kidney disease is diagnosed as a result of screening of people known to be at risk of kidney problems, such as those with high blood pressure or diabetes and those with a blood relative with chronic kidney disease. This disease may also be identified when it leads to one of its recognized complications such as cardiovascular disease, anemia, or pericarditis. Methods Sysmex kx21 used to CBC and the Cobase411 used to iron profile. Enzyme-Linked immunoassay (ELISA) was used to determine the level of serum hepcidin. Sample preparation and PCR detection of HAMP DNA Polymorphisms: Restriction digestion of PCR products was done using Fast Digest. (Figure 1). Results Serum hepcidin levels higher in patients with anemia of chronic kidney disease compared with healthy controls mean. The polymorphisms of the hepcidin gene promoter in Sudanese patients with ACKD showed that the hepcidin HAMP AA genotype 70, AG 23, and GG 7 in 100 patients dialysis-dependent and AA 83, AG 17 and GG 0, and the allele A are more frequent in patients affected by ACKD. Significant statistical association observed between the hepcidin level and end-stage kidney disease. Conclusion This study evaluates for the first time the association between anemia of chronic kidney disease and hepcidin genes promoter polymorphisms and show that the hepcidin HAMP AA genotype and the allele A are more frequent in patients affected by ACKD, further investigation is needed, our data support the hypothesis and hepcidin HAMP are important in the pathophysiology of ACKD.
Dec 2017 DOI 10.14302/issn.2576-9359.jot-17-1807
J. Schutt RyanCorresponding author
Scripps Center for Organ and Cell Transplantation, Scripps Green Hospital, 10666 North Torrey Road, La Jolla, California
Purpose Intra-operative insults may subject living kidney transplants to poor outcomes. Therefore, we investigated whether intra-operative recipient and donor hemodynamics could act as predictors of delayed graft function and subsequent outcomes. Materials and Methods Living kidney donors and recipients from 2010-2016 at this institution underwent a retrospective chart review. Graft function by post-operative day 7 was used to classify recipients as delayed graft function (need for dialysis), slow graft function (creatinine > 2.5) and good function. Groups were analyzed for intra-operative hemodynamic differences and at one year, incidence of rejection, graft function and survival were compared. Results A total of 111 living renal transplants were performed. Average recipient age was 50 and just over halfwere male (53%). 9% (n=10) and 10% (n=11) developed delayed graft function and slow graft function, respectively. Minimum recipient post re-perfusion central venous pressure ≥12 mmHg was associated with poor graft function (delayed graft function/slow graft function/good function=67%/56%/24%, p=0.009), while intra-operative hypotension (systolic <90 mmHg or diastolic <50 mmHg) was not. Delayed graft function and slow graft function had higher incidences of rejection than good function (30% and 36% vs 9%, p=0.012). Graft function and survival were similar. One patient died with a functioning graft. Conclusions This single center retrospective study suggests that a post re-perfusion central venous pressure ≥12 mmHg is associated with delayed graft function.
Aug 2017 DOI 10.14302/issn.2372-6601.jhor-17-1606
O OsmanCorresponding author
Consultant nephrologist, Alqunfudah Hospital, KSA.
Several interactions exist between thyroid and kidney function in many disorders. Many publications explored the relationship between thyroid diseases (TD) and chronic kidney diseases (CKD). However, the morphological thyroid changes in patients with CKD or End Stage Kidney disease (ESKD) were not fully explored. The aim of this study is to explore the morphological and the functional abnormalities of the thyroid gland among ESKD patients as detected by Doppler ultrasound. Patients and Methods: All of the 92 ESKD patients at our center were consented and included in the study. Demographic and clinical data and biochemical and hormonal profiles were recorded. Every patient received a dedicated ultrasound scan of the thyroid gland. GE ultrasound system with Doppler capabilities and high frequency transducer was used. Grey scale imaging and Doppler ultrasound were used to image the thyroid gland for every patient. Taking the thyroid morphology detected by ultrasound and the thyroid function as the dependent variables, all other parameters of age, sex, BMI, occupation, residence, duration of time on dialysis and other comorbilities were taken as independent variables and their relationship to the dependent variables was further studied using appropriate statistical tests. Results: Thyroid nodule(s) presence was found to be the most prevalent thyroid morphology detected on ultrasound scanning. Fifty three patients (57.6%) were found to have ultrasound detected nodule(s). The nodule presence was correlated to different independent variables and was found to significantly correlate with age only. The thyroid function as reflected by the level of thyroid hormones was also studied for correlation with the independent variables. No correlation was found between the thyroid function and the presence of nodules. Conclusion and Recommendation: Ultrasound detected nodules are very common in ESKD patients. The presence of nodule significantly correlates with patient age denoting its degenerative nature. Ultrasound screening of the thyroid in ESKD patients may be cost effective. However, we recommend a larger multicenter study for better results.
Mar 2017 DOI 10.14302/issn.2476-1710.jdt-16-1262
Schoenfeld R.Corresponding author
Martin Luther University Halle-Wittenberg, Department of Psychology, Halle, Germany
Background. Emotional deterioration is frequently found in patients with chronic kidney disease, but some patients are affected by depressed mood without fulfilling the criteria of a depressive disorder. Those patients might rather suffer from an apathy symptom. Apathy as a symptom of a medical disease is accompanied by loss of motivation and interest, cognitive impairments, and emotional distress. Our study tested how groups of apathetic and depressed chronic kidney disease patients responded to a single haemodialysis session on measures of mood. Methods. 21 haemodialysis patients were assigned to subgroups (depressed, apathetic only, without depression and apathy) according to clinical relevant cut-offs. Sensitive questionnaires were administered to monitor mood state in general and mood changes before and after a single haemodialysis session in the chronic kidney disease patients. The results were compared to 20 age-matched healthy controls receiving no treatment. Results. Fortheen dialysis patients had eighter apathy or depressen and seven had neighter apathy nor depression. Mood state was seriously affected in all haemodialysis patients with depressed patients showing the largest effect compared to healthy controls. Patients with apathy and patients without apathy and depression were comparable in their mood state. We observed a positive mood change after the haemodialysis only in patients without apathy and depression. Their mood state improved significantly and reached nearly the level of healthy controls. Conclusions. The absence of a short-term mood change in apathetic dialysis patients makes them comparable to dialysis patients with depression. We argue that apathetic patients lack the probable mood brightening effect of the haemodialysis. The lack of emotional improvement by dialysis sessions could also lead to decreased adherence of the patients. Hence, apathy seems to be a serious symptom in chronic kidney disease that is worth to be considered at least in the diagnostic process. Accompanying psychotherapeutic care for these patients would be desirable
Oct 2016 DOI 10.14302/issn.2574-4488.jna-16-1225
S. Soni SachinCorresponding author
Consultant Interventional Nephrologist, United Ciigma Hospital, Aurangabad
Arteriovenous fistula is the most commonly used vascular access in patients on maintenance hemodialysis. Operating surgeon has to be aware about the normal anatomy of vessels as well as variations in the course of the vessels. Here wereport a case of radiocephalic arteriovenous fistula constructed in aberrant radial artery. This is the first case of arteriovenous fistula with aberrant radial artery to be reported in world literature.
Dec 2015 DOI 10.14302/issn.2372-6601.jhor-14-397
Gabbay EzraCorresponding author
Division of Adult Nephrology,
Immunotactoid glomerulopathy (ITG) is a rare cause of chronic kidney disease (CKD) and end-stage-renal-disease (ESRD). It is often associated with monoclonal gammopathy and/or hematologic malignancy. We report a patient originally diagnosed with ITG in 1998. He presented with nephrotic-range proteinuria, hypertension, and a gradual decline in glomerular filtration rate. A published case report of this patient at the time the disease was originally diagnosed described only a small peak of IgM paraprotein without lymphoma or plasma cell dyscrasia. He was diagnosed with monoclonal gammopathy of unknown significance. He later developed ESRD and initiated hemodialysis in 2004. Fourteen years after the diagnosis of ITG and MGUS was made he developed headache, lymphadenopathy, borderline splenomegaly, thrombocytopenia, and coagulopathy. Workup revealed a very high level of monoclonal IgM-kappa (4390 mg/dL),and low grade B-cell lymphoma, consistent with lymphoplasmacytic lymphoma, leading to a diagnosis of Waldenstrom’s macroglobulinemia (WM). He died shortly thereafter of complicated gram-negative sepsis. To our knowledge this is the first report of WM associated with ITG. The patient's course illustrates that plasma cell dyscrasia and lymphoma can present many years after the original diagnosis of ITG is made and that continued vigilance for these conditions is warranted.