Assessment of cognitive dysfunction in kidney disease

Background: Cognitive dysfunction, include reducedmental alertness, intellectual impairment, decreasedattention and concentration, memory deficits anddiminished perceptual-motor coordination. Both CKDand chronic dialysis patients are thought to be associatedwith cognitive impairment. Cognitive impairment maydecrease an individual's quality of life, increase resourceutilization and result in suboptimal medical care.Neurophysiologic tests using imaging techniques areused to evaluate structural and functional abnormalities.Neuropsychological testing uses validated questions andscreening tests to evaluate cognition.Setting and participants: This study was carried out on120 patients with different stages of CKD fromnephrology outpatient clinic and hemodialysis unit inAin Shams University Hospitals. Group I: 50 CKDpatients, stage ? and stage IV. Group II: 50 ESRDpatients on regular hemodialysis with K t/v > 1.1. GroupIII: 20 acute kidney injury patients, followed up till theirrenal functions stabilized. Group ?V: 20 healthy subjectsmatched with patients. All patients underwent laboratoryinvestigations and psychometric tests which include trialmaking test part B, digit span test, digit symbol test,mini-mental state examination.Results: There were highly significant differences ofmean values of cognitive function tests between (groupsI,II and III as compared with group IV (control group),stage III CKD and stage IV CKD, CKD andhemodialysis patients, AKI patient at the insult and afterrecovery) and finally between hemoglobin and cognitivefunction tests score.Conclusions: There were significant differences of cognitive function tests results between CKD, III,IV,V, AKI patients as compared with healthy group, suggesting that kidney disease affects cognitive performance, there were significant differences of cognitive function tests results between stage III CKD and stage IV CKD, suggesting that the degree of cognitive impairment is associated with the severity of CKD, also significant differences of cognitive function tests results between CKD and ESRD on hemodialysis, suggesting that dialysis improves cognitive performance. Our results showed significant differences of cognitive function tests results between AKI patients at the insult and after recovery, suggesting that AKI also impair cognitive function. Finally cognitive performance is affected by hemoglobin level in CKD stage III, IV, V on hemodialysis and AKI patients, suggesting that treatment of anemia in AKI, CKD and ESRD patients improve cognitive performance

Assessment of cognitive dysfunction in kidney disease

Cognitive dysfunction includes reduced mental alertness, intellectual impairment, decreased attention and concentration, memory deficits and diminished perceptual-motor coordination. Chronic kidney disease (CKD) patients may suffer from cognitive impairment, which may decrease an individual′s quality of life, increase resource utilization and result in suboptimal medical care. This study was carried out on 120 patients with different stages of CKD from our nephrology outpatient clinic divided into three groups: Group I: 50 CKD patients, stage 3 and stage 4; Group II: 50 end-stage renal disease patients on regular hemodialysis with K t/v >1.1; and Group III: 20 acute kidney injury patients, followed-up till their renal functions stabilized besides Group IV: 20 healthy subjects served as controls. All patients underwent laboratory investigations and psychometric tests, which include trial making test part B, digit span test, digit symbol test and mini-mental state examination. There was a significant difference of mean values of cognitive function tests in Groups I, II and III on comparing them with Group IV. Stage 3 CKD scored better than stage 4 CKD, which was worse than hemodialysis patients, and lastly acute kidney injury patients had mild cognitive impairment, which was restored after recovery. We found an association between hemoglobin and cognitive function tests score in the studied groups. The degree of cognitive impairment was associated with the severity of CKD, and dialysis improved cognitive performance

Relationship between asymmetric dimethylarginine plasma level and left ventricular mass in hemodialysis patients

Left ventricular hypertrophy (LVH) and left ventricular dysfunction are highly prevalent in patients with end-stage renal disease (ESRD). Several studies suggest that left ventricular mass and function is strongly modulated by the nitric oxide (NO) system. Asymmetric dimethylarginine (ADMA), an endogenous inhibitor of endothelial-based NO synthase, is emerging as an important cardiovascular risk factor in ESRD patients. Our objective is to evaluate the relationship between plasma ADMA level and LVH among hemodialysis (HD) patients. Plasma ADMA measurements by enzyme-linked immunesorbent assay and echocardiographic evaluation were performed for 40 patients on regular HD, 20 patients with pre-dialysis chronic kidney disease, 20 hypertensive patients with left ventricular hypertrophy and normal kidney function and 20 healthy age and sex-matched subjects as a control group. Residual renal function (RRF) was measured in HD patients by urea clearance from a urine collection. Mean values of plasma ADMA level were significantly high in all patient groups when compared with the control group (P 0.05) and between ADMA and RRF in HD patients (r = -0.20, P = 0.60). It was also seen that plasma ADMA was not correlated with left ventricular mass index; however, there could be an association between ADMA level and diastolic dysfunction. The plasma ADMA level was found to be high in the three studied patient groups in comparison with the control group. HD is not an effective procedure for adequate removal of ADMA

Proteinuria in Egyptian renal transplant recipients

To evaluate the prevalence, risk factors, possible etiology, prognosis and management of proteinuria in renal transplant recipients, we studied 435 adult renal transplant recipient patients randomly selected from our center; 394 patients were reviewed retrospectively and 41 patients were followed-up prospectively for a period of one year. The patients were classified into three groups according to the results of urinalysis and spot urinary albumin creatinine ratio: Group A patients with normoalbuminuria; Group B patients with microalbuminuria; and Group C patients with macroalbuminuria. Persistent post-transplantation proteinuria was detected in 125 (28.8%) patients. The etiology of post-transplantation proteinuria included chronic allograft dysfunction in 44 (35.2%) patients, acute rejection in 40 (32%) patients, transplant glomerulopathy in eight (6.4%) patients, glomerular disease in 16 (12.8%) patients and other etiology in 17 (13.6%) patients. Proteinuric patients demonstrated significantly lower graft survival rates than did those without proteinuria (48.3% versus 51.7%, respectively; P = 0.017; Risk Ratio = 0.403; 95% confidence interval 0.188-0.862). We conclude that proteinuria is prevalent after kidney transplant in our population, and that it is most commonly associated with chronic allograft nephropathy, transplant glomerulopathy, glomerulonephritis and acute rejection. Post-transplant proteinuria is associated with decreased allograft survival