Hemodialysis associated dysautonomia; Effect of optimization of dialysis and nutrition: A prospective study

Background: Autonomic neuropathy is common among hemodialysis patients, even if they are asymptomatic. The aim of this study is to assess the effect of optimization of patients' dialysis and nutrition on the presence of autonomic dysfunction in these patients guided by sympathetic skin response (SSR) test. Methods: Fifteen patients on maintenance hemodialysis (12 males and 3 females) their age ranged from 24 to 67 years, most of them were on bicarbonate dialysis were included in our study. Initially, the patients were assessed clinically and by laboratory investigations and their dialysis was assessed by studying their urea kinetic modeling. Their nutrition was assessed by laboratory parameters and by calculating the normalized protein catabolic rate (nPCR). Their autonomic functions were assessed by clinical examination, hand grip and SSR test. Dialysis dose was readjusted to achieve a target kt/v value of 1.3/session thrice weekly. Also, their nutrition was reviewed to achieve nPCR of 1.2 gm/kg/day and caloric intake of 30-40 KCal/kg/day through diet manipulation and support. They were reassessed after 3 months. Results: Analysis of the data showed a statistically significant improvement of the observed subclinical autonomic neuropathy evidenced by a significant change in the hand grip (p = 0.044), and a high statistically significant improvement in the sympathetic skin response test parameters (both amplitude and latency) (p=0.001) after optimization of both hemodialysis and nutrition status. Conclusion: Improving dialysis and patients nutrition by using urea kinetic modeling is valuable in improving their autonomic functions as assessed by SSR test

Post-transplant anemia in pediatric patients and its impact on patient and graft survival: single center experience

Introduction: Post-transplantation anemia (PTA)occurs frequently, with prevalence rates between 20and 60% depending on the criteria used for defininganemia.Aim of the work: We aimed to assess the prevalenceof anemia after 6 months of transplantation inpediatric renal transplant patients under differentprotocols of immunosuppression, and to determinethe impact of anemia upon long-term patient andgraft survival.Patients and methods: Based on the data of 108renal transplants performed in our center, patientswere categorized after 6 months according to theirhemoglobin (Hb) levels into two groups. The firstgroup with Hb more than 11gm/dl (group I, 29cases) and the second group with Hb lessthan11gm/dl (group II, 79cases). We compared thetwo groups regarding post transplant complications(rejection episodes, hypertension, diabetes mellitus,infections, hepatic dysfunction, and patient andgraft survival.Results: we found no significant difference betweenthe two groups regarding rejection episodes.However, the percentage of cases with chronicallograft nephropathy was significantly higher in the anemic group. The survivors with functioning graftswere significantly higher in cases with normal Hb.Moreover, living cases with graft failure weresignificantly higher in anemic group. Graft survivalrate was better in the non anemic group. However,no difference in patient survival was detected. Also,we found no difference between the two groupsregarding post-transplant complications.Conclusions: From this study, we can conclude thatthe prevalence of post-transplant anemia is highpediatric renal transplant patients especially thosereceiving CNI and MMF, and it was associated withpoorer graft outcome but no effect on patientsurvival

Design and implementation of the European-Mediterranean Postgraduate Programme on Organ Donation and Transplantation (EMPODaT) for Middle East/North Africa countries

This prospective study reports the design and results obtained after the EMPODaT project implementation. This project was funded by the Tempus programme of the European Commission with the objective to implement a common postgraduate programme on organ donation and transplantation (ODT) in six selected universities from Middle East/North Africa (MENA) countries (Egypt, Lebanon and Morocco). The consortium, coordinated by the University of Barcelona, included universities from Spain, Germany, Sweden and France. The first phase of the project was to perform an analysis of the current situation in the beneficiary countries, including existing training programmes on ODT, Internet connection, digital facilities and competences, training needs, and ODT activity and accreditation requirements. A total of 90 healthcare postgraduate students participated in the 1-year training programme (30 ECTS academic credits). The methodology was based on e-learning modules and face-to-face courses in English and French. Training activities were evaluated through pre- and post-tests, self-assessment activities and evaluation charts. Quality was assessed through questionnaires and semi-structured interviews. The project results on a reproducible and innovative international postgraduate programme, improvement of knowledge, satisfaction of the participants and confirms the need on professionalizing the activity as the cornerstone to ensure organ transplantation self-sufficiency in MENA countries

Effect Of Hepatitis C Virus Infection On Haematocrit And Haemoglobin Levels In Egyptian Hemodialysis Patients

Aim: Hepatitis C virus (HCV) infection is common among the Egyptians. This prevalence is higher among hemodialysis (HD) patients in whom anemia is a common finding. Recently, some case reports and few studies indicated that red cell status increased after hepatitis C viral infection among HD patients. The aim of our study is to investigate whether HCV-positive HD patients have higher hemoglobin (Hb) and hematocrit (HCT) values compared to HCV-negative patients. Methods: Ninety-nine chronic (HD) patients were the subject of this study. Their HCV status was determined by anti-HCV antibodies and confirmed with RNA polymerase chain reaction (PCR). Those with a history of blood transfusion or massive blood loss during the last 6 months were excluded from the study. Results: 70.7% of our patients tested positive for anti-HCV antibody (56.9 % were male). The mean age for HCV positive group was (40.41±14.17 years) while it was (47.35±19.18 years) for HCV negative group (P=0.08). HCV positive group has a longer hemodialysis duration (66.54 ± 43.92 months) compared to HCV negative patients (30.96±23.17 months, P=0.006). Mean Hb was similar in HCV-positive compared to HCV negative group (10.32±2.03 versus 10.22±1.52 gm/dl respectively) (P=0.63). Mean HCT values were also similar in both groups being 30.94± 6.089% in HCV positive versus 30.77± 4.53% in HCV negative group, respectively (P= 0.094). Fifty-five patients (39 HCV positive and 16 were HCV negative) received erythropoietin (EPO) therapy whilst only twenty patients received IV iron. Mean Erythropoietin dose was 5000±2236.06 Units/week in HCV- positive patients versus 6250±2720.29 Units /week in HCV - negative group (P=0.09). Liver function tests were normal except for alanine aminotransferase (ALT) that was significantly higher among HCV-positive compared to HCV-negative patients (31.75±36.4 vs 15.1±7.21 U/L, P=0.05). Conclusion: HCV-positive and HCV-negative Egyptian chronic hemodialysis patients have comparable hemoglobin as well as hematocrit levels and the erythropoietin dose was not influential as its lower value in HCV-positive patients did not reach a statistically significant level

Impact of CD 28, CD86, CTLA-4 and PD-1 genes polymorphisms on acute renal allograft rejection and graft survival among Egyptian recipients

Abstract To study the impact of four gene polymorphisms on acute renal allograft rejection (AR) and graft survival among Egyptian population. These 4 gene polymorphisms include: (1) CD 28 (rs3116496), (2) CD86 (rs1129055), (3) CTLA-4 (rs3087243), (4) PD-1 (rs2227982). This is a non-concurrent cohort study including 50 kidney transplant recipients diagnosed histopathologically as (AR) [study group] and another 50 matched allograft recipients without AR [control group]. Blood samples were taken from both groups and subjected to genotyping for the selected four genetic polymorphisms by TaqMan genotyping assay. The difference in genotypic distribution of CD 28: rs3116496 and CD86: rs1129055 wasn't statistically significant between the study and control groups (P = 0.22 and 0.33 respectively) and also both polymorphisms had no effect on graft survival (P = 0.36 and 0.74 respectively) while the addition of C allele to IVS3 +17T/C polymorphism in CD28 gene showed a protective effect against AR (P = 0.03). CTLA-4: rs3087243 AG genotype showed a protective effect against AR as it was more frequent in no rejection group compared to those with AR (P = 0.001) with a statistically significant impact on graft survival (P < 0.001), while PD-1: rs2227982 AG genotype was equally distributed between both groups (variant of unknown significance). There was no detected association between CD86 polymorphism: rs1129055 and CD 28 polymorphism: rs3116496 with the development of AR. However, C allele of CD 28 IVS3 +17T/C polymorphism and CTLA-4 polymorphism: rs3087243AG genotype both demonstrated a protective effect against AR

ORIGINAL ARTICLE - SERUM CYSTATIN C: A GOOD MARKER FOR EVALUATION OF GLOMERULAR FILTRATION RATE IN HEPATORENAL SYNDROME

To determine if estimation of serum cystatin C could replace creatinine clearance in routine determinations of glomerular filtration rate (GFR) for early detection of kidney affection in patients with cirrhosis in a case control study. 40 patients with cirrhosis were included in this study according to Child-Pugh's classification, 20 patients (group C) and 20 patients (group B). Twenty adults aged, sex and body mass index matched were used as controls. Serum creatinine and creatinine clearance were measured by Jaffe reaction. GFR was measured by 99m Tc-DTPA technique. Serum cystatin C was measured by particle enhanced immunoturbidimetry. Pearson correlation analyses showed that cystatin C has no correlation with age or body mass index. Moreover, cystatin C showed more significant correlation r = -0.85, p <0.001, than serum creatinine r = -0.32, p <0.05 with GFR measured with 99mTc-DTPA technique in patients with cirrhosis. The results demonstrated that serum cystatin C values were significantly higher in hepatorenal syndrome patients than in controls. Results showed that neither serum creatinine nor creatinine clearance were good indicators of hepatorenal syndrome(r = 0.089). Serum cystatin C level is independent of age or body mass index. Thus we suggest that serum cystatin C assay may be useful marker for early detection of renal insufficiency in hepatorenal syndrome. Also, the increase in cystatin C is higher in decompansated cirrhotic patients than in compensated cirrhotic patients

Evaluation of Fluoroquinolones for the Prevention of BK Viremia after Renal Transplantation

Background and objectives: Nearly 30% of renal transplant recipients develops BK viremia, a prerequisite for BK nephropathy. Case reports have evaluated treatment options for BK virus, but no controlled studies have assessed prophylactic therapies. Fluoroquinolone antibiotics were studied for prevention of BK viremia after renal transplantation