End-stage Chronic Kidney Disease Research Articles

Use of the BIOGROUP® French laboratories database to conduct CKD observational studies: a pilot EPI-CKD1 study.

Medical biology is essential for diagnosing and monitoring cardio-reno-metabolic diseases. The EPI-CKD1 study utilizes data from Biogroup® French laboratories to examine the burden of chronic kidney disease (CKD) and the effect of heart failure, and diabetes in an outpatient setting in order to address gaps in national databases that lack biological data. All adults (≥18 years) with at least one blood creatinine test between January 1st of 2021, and June 30th of 2022 were included. Key biomarkers measured included serum creatinine, estimated glomerular filtration rate (eGFR), hemoglobin A1c, B-type natriuretic peptide (BNP), NT-Pro BNP, and urinary albumin/creatinine ratio (uACR). Among a total of 4,061,208 adults with at least one blood creatinine test, 465,225 (11.5 %) had altered kidney function. Their mean age was 57.9 years (SD 18.8), with 56.7 % women. Diabetes was present in 8.3 %, and heart failure in 1.4 %. Altered kidney function standardized prevalence was estimated to 8.06 %, with an incidence of 5.10 %. Patients with end-stage CKD had an average of 7.9 eGFR measurements, compared to 2 for those with eGFR >60 mL/min/1.73 m2. Older age, diabetes, and heart failure were associated with an increased risk of eGFR <60 mL/min/1.73 m2. The EPI-CKD1 study demonstrates the utility of Biogroup® data for large-scale observational studies, offering precise, medically relevant insights on patients at cardio-renal risk. Future studies should focus on data enrichment and long-term follow-up to deepen understanding.

Association of XRCC1 (rs1799782) and XPD (rs13181) gene polymorphisms with renal failure risk in a sample of Iraqi population: a case-control study.

End-stage chronic kidney disease (CKD) can lead to life-threatening complications and is caused primarily by CKD and cardiovascular issues. CKD is characterized by the inability of the kidneys to filter waste and excess fluids from the blood. This study investigated the associations of the genetic variants XRCC1 rs1799782 (C194T) and ERCC2/XPD rs25487 (Q399R) with CKD susceptibility in Iraqi patients and related biochemical changes. The research was performed from 25/01/2023 to 30/06/2023, we analyzed the genetic associations of two SNPs of DNA repair genes (XRCC1 and ERCC2/XPD) in a case‒control study involving 219 CKD patients diagnosed by a nephrologist and 246 healthy controls. Data and blood samples were collected, and the genotype distribution frequency was determined via the PCR-based high-resolution melting (PCR-HRM) technique. This study included 465 participants, with 219 CKD patients and 246 healthy controls. XRCC1 and ERCC2/XPD gene polymorphisms were significantly associated with CKD susceptibility in Iraqi patients (p = 0.025 and p = 0.0001, respectively). Multivariate linear regression confirmed the associations of rs1799782 G/A and rs13181T/G with CKD, adjusting for sex, age, and BMI. Moderate and statistically significant linkage disequilibrium (0.43) between the two SNPs was observed, indicating nonrandom associations. XRCC1 (rs1799782) and ERCC2/XPD (rs13181) polymorphisms are associated with an increased risk of CKD. The AG haplotype model is particularly related to increased CKD susceptibility in Iraqi patients, suggesting the importance of these DNA repair gene polymorphisms in CKD risk assessment.

DMARD therapy of inflammatory rheumatic diseases in end-stage kidney disease.

Background Inflammatory rheumatic diseases regularly require the use of disease-modifying anti-rheumatic drugs (DMARDs). The use of DMARDs in patients with end-stage chronic kidney disease (CKD stage 5D) is particularly challenging due to the lack of systematic studies available for this patient population. This narrative review aims to address the aspect of DMARD therapy in CKD 5D. Summary The current article is a narrative review. References were sourced from the following databases: PubMed, Web of Science, Cochrane Library, and Scopus. The search period spanned from 1975 to 2024. There is a notable lack of systematic data on this topic. The available literature was reviewed to provide insights, despite the limited availability of comprehensive studies. Individuals with terminal kidney disease can presumably be safely treated with leflunomide, mycophenolic acid, sulfasalazine, azathioprine, belimumab, and anti-CD20. For all other substances, there are either significant restrictions, insufficient data, or inadequate experience. Key messages - Some conventional and biologic DMARDs are available for the management of inflammatory rheumatic diseases in CKD stage 5D. - It is essential to consider the limitations on kidney function, as they can significantly affect the pharmacokinetics of medications. - Consequently, slightly more frequent check-ups are recommended when using the defined preparations.

A pictorial neuroradiological review of brain vascular abnormalities in patients with kidney disease.

A pictorial neuroradiological review of brain vascular abnormalities in patients with kidney disease.

Design and psychometric validation of a social capital questionnaire for adults with end-stage chronic kidney disease undergoing dialysis or hemodialysis

BackgroundThe effects of end-stage kidney disease (ESKD) can spill over into a patient’s social life. Social capital (SC) is a determinant of health that can enhance patients’ health through support and resources. However, no questionnaire is currently available to measure SC in ESKD patients. This study aimed to design and validate a questionnaire to measure SC in ESKD adults undergoing dialysis or hemodialysis.MethodsA mixed methods approach was used to generate the questionnaire and determine its content validity with a panel of nine experts and content validity index, face validity through cognitive interviews with patients, construct validity (exploratory and confirmatory factor analysis), criterion validity, reliability and the effect of known groups differences.ResultsContent validity was confirmed by an expert panel, achieving a content validity index value > 0.85 for all items. Face validity was achieved through cognitive interviews with 20 patients over 18 years of age in a terminal stage of CKD, ensuring that the target population understood the questions. An exploratory factor analysis used the sample of 610 patients and tested the structure of the seven dimensions of the structural domain (participation in organizations, links to institutions, social network sizes, collective activities, diversity, bridging, and bonding) and explained 95.7% of the total variance with a reliability of 0.89, and criterion validity > 0.32 (p < 0.05) for the correlations between the indices of each dimension and the domain index. The structure of the cognitive domain was tested for six dimensions (norms of reciprocity, social harmony, feeling of belonging, perceived fairness, social support, and social trust) with a total variance of 80.7%, reliability of 0.94 and criterion validity for correlations > 0.68 (p < 0.05). The confirmatory factor analysis with 352 patients proved the factorial structure adequate for both questionnaire domains and all dimensions, with CFI and TLI values > 0.9, an RMSEA ≤ 0.06, and SRMR ≤ 0.05.ConclusionsWe conclude that the questionnaire designed to measure social capital is valid and reliable for ESKD patients in Mexico.

Bone mineral density and its risk factors in patients with end-stage chronic kidney disease on hemodialysis

Background. Patients with end-stage chronic kidney disease (CKD) undergoing hemodialysis are at high risk for decreased bone mineral density (BMD), leading to osteopenia and osteoporosis. Various factors, including age, sex, menopausal status, and duration of hemodialysis, can influence BMD loss, necessitating early detection and management. Aim. To evaluate the correlation between risk factors – such as age, sex, menopausal status, and duration of hemodialysis – and decreased BMD in CKD patients undergoing regular hemodialysis, using dual-energy X-ray absorptiometry (DXA) as the diagnostic standard. Results. A cross-sectional study of 63 CKD patients (aged 18–70 years) found that 61.9% had osteopenia or osteoporosis at the lumbar spine, with over 70% affected at the hips. Significant correlations were identified between reduced lumbar BMD and both age (p=0.035) and menopausal status (p=0.018). Although longer hemodialysis duration and comorbidities such as hypertension and diabetes mellitus showed trends toward lower BMD, these associations did not reach statistical significance. Conclusion. Age and menopausal status are significant predictors of reduced BMD in CKD patients on hemodialysis. Routine DXA screening and targeted interventions are essential to mitigate fracture risk and improve patient outcomes.

Optimizing Oncological Care in Patients with End-Stage Chronic Kidney Disease on Dialysis: Indian Scenario

Optimizing Oncological Care in Patients with End-Stage Chronic Kidney Disease on Dialysis: Indian Scenario

Anticipatory Care Plan for End-Stage Chronic Kidney Patients – Case Report

Chronic Kidney Disease is characterized by progressive, persistent, and irreversible loss of kidney function, with a high prevalence and increasing trend in the population. An important observation, common to all recent studies, is the constant changes experienced by these individuals. Analytical changes, health status and the patient's preferences should be considered when planning anticipatory care at any phase of the disease. To comprehend the significance of the Anticipatory Care Plan for Patients with End-Stage Chronic Kidney Disease, a descriptive case report was conducted following the Case Report (CARE) guidelines. This case involves an 87-year-old male undergoing hemodialysis since 2020. His medical history includes diabetes, chronic wounds in the lower limbs, and frequent emergency room visits due to severe dyspnea and worsening of wound conditions. Upon observation, the patient appeared to be in significant distress, with generalized edema, skin the presence of respiratory noises and dyspnea, dry skin, and complaining of grade 7 pain in the lower limbs. The family had limited information about the situation. Symptomatic management of pain and dyspnea became imperative, alongside the determination of an appropriate anticipatory care plan. The case report highlights the necessity and importance of implementing an anticipatory care plan so that, even at the end of life, the wishes of the patient and their family are fulfilled, improving the quality of life for both. Developing the anticipatory care plan at an earlier stage, with the involvement of the patient, family, and healthcare professionals, is associated with improved patient comfort outcomes.

ZDHHC18 promotes renal fibrosis development by regulating HRAS palmitoylation.

Fibrosis is the final common pathway leading to end stage chronic kidney disease (CKD). However, the function of protein palmitoylation in renal fibrosis and underlying mechanisms remain unclear. In this study, we observed that the expression of the palmitoyltransferase ZDHHC18 was significantly elevated in unilateral ureteral obstruction (UUO) and folic acid (FA)-induced renal fibrosis mouse models, and was significantly upregulated in the fibrotic kidneys of chronic kidney disease patients. Functionally, tubule-specific deletion of ZDHHC18 attenuated tubular epithelial cells partial epithelial-to-mesenchymal transition (EMT), then reduced production of profibrotic cytokine and alleviates tubulointerstitial fibrosis. In contrast, ZDHHC18 overexpression exacerbated progressive renal fibrosis. Mechanistically, ZDHHC18 catalyzed the palmitoylation of HRAS, which is pivotal for its translocation to the plasma membrane and subsequent activation. HRAS palmitoylation promoted downstream phosphorylation of MEK/ERK and further activated RREB1, enhancing SMAD binding to the Snai1 cis-regulatory regions. Taken together, our findings suggest that ZDHHC18 plays a crucial role in renal fibrogenesis and presents a potential therapeutic target for combating kidney fibrosis.

Design and application of an intelligent temperature-controlled peritoneal dialysis belt

Peritoneal dialysis (PD) is one of the main renal replacement therapy methods for patients with end-stage chronic kidney disease, and peritoneal dialysis belt is a key auxiliary device. However, there are some problems in the existing PD technology, such as the separation of heating system and dialysate system, the inability to continuously heat dialysate and the single function of peritoneal dialysis belt. In order to solve the above problems, the staff of Shanghai Geriatric Medical Center designed an intelligent temperature-controlled peritoneal dialysis belt and obtained the National Utility Model Patent of China (patent number: ZL 2023 2 1815961.9). The intelligent temperature-controlled peritoneal dialysis belt is composed of a double-layer fixed belt, an intelligent temperature control system (including temperature control structure and intelligent control system) and other auxiliary structures. The peritoneal dialysis tube can penetrate into the dissection from the entry of the inner surface of the fixed belt and pass through the exit of the outer surface. The double-layer fixed belt ensures the stable fixation of the dialysis tube. The two ends of the fixing belt are designed with magic stickers to adjust the tightness of the fixing belt to adapt to people with different waist circumferences. The interlayer is equipped with an intelligent temperature control system, which can continuously heat the dialysate through an electric heating plate to maintain a temperature close to the body temperature. Through the display screen and controller on the intelligent control system, medical staff can be allowed to monitor and adjust the temperature, pressure and flow parameters of the dialysate in real time. In addition, a cloth with a pulling chain is designed on the inner surface of the fixed belt, and the cloth is opened to facilitate the medical staff to wear the peritoneal dialysis tube in the temperature control structure or the restraint belt. The intelligent temperature-controlled peritoneal dialysis belt enhances the effectiveness of PD, saves PD resources, improves the convenience of PD, is suitable for family and hospital use, can effectively improve the quality of life of patients with chronic renal failure, and is suitable for clinical promotion.

Role of peroxisomes in the pathogenesis and therapy of renal fibrosis.

Role of peroxisomes in the pathogenesis and therapy of renal fibrosis.

P-555. Use of Long-Acting Cabotegravir/Rilpivirine in People Living with HIV with Renal Transplantation

Abstract Background Cabotegravir/Rilpivirine (CAB/RPV) represents a novel combination of long-acting injectable antiretroviral therapy (LAIART). Although the unique benefits of LAIART have been demonstrated in large clinical trials among people with HIV, including a favorable safety profile, few drug-drug interactions, and viral control without a daily oral pill requirement, evidence of LAIART use among PWH diagnosed with end-stage chronic kidney disease (CKD) and during kidney transplantation (KT) remains sparse. Detailed timeline of all 3 patients in the study. Methods A phase IV clinical trial CAPRI (NCT05601128) was designed to evaluate the pharmacokinetics and safety of long-acting CAB/RPV among PWH with CKD &amp;gt;= stage 4 or ongoing hemodialysis. Three enrolled participants were included, in this analysis because of their KT status, of them, one KT before the trial and two KT during the trial. The peri- and post-operative effects of CAB/RPV LA were evaluated focusing on viral load, CD4+ counts, and potential drug interactions. According to protocol, CAB/RPV PK samples were obtained and planned to be measured and analyzed. Results All three participants have been virally suppressed (&amp;lt; 50 copies/ml) by CAB/RPV LA with stable CD4+ counts while maintaining appropriate graft function during 12months of study period. The timeline for each participant was depicted in the Figure and details were summarized in terms of virologic and immunologic outcomes as well as renal function at different study periods. CAB/RPV LA was well tolerated, without major related adverse events noted. The renal function was significantly improved, dialysis free, in two participants receiving KT during the trial whereas it remained stable, dialysis free, in the participant with prior KT. The reported tacrolimus trough concentrations were maintained within the therapeutic range to protect the graft function. Conclusion The safety and efficacy of CAB/RPV LA have been observed in these participants, supporting its potential use among those with severe renal impairment and kidney transplantation. Additional advantages including lack of adherence barriers and low drug interaction potential are likely to increase viral suppression and improve overall quality of life in this special population. Disclosures Chiu-bin hsiao, MD, Viiv, Gilead: Grant/Research Support

Neuropsychological Profile in Older Adults with End-Stage Kidney Disease during Kidney Transplantation Evaluation.

Neuropsychological Profile in Older Adults with End-Stage Kidney Disease during Kidney Transplantation Evaluation.

A black cecum: diagnostic challenges and conservative management.

A 51-year-old man with type 1 diabetes mellitus and end-stage chronic kidney disease on hemodialysis presented with 12 hours of lower right quadrant abdominal pain and bloodless diarrhea. Examination showed tenderness without guarding. Blood tests showed leukocytosis (12200/microl) and elevated C-reactive protein (190 mg/L). Abdominal CT showed ascending colon thickening (~10 cm), mesenteric fat densification, and small locoregional ganglia, without signs of arterial/venous obstruction. Given the diagnostic doubt, colonoscopy was performed and revealed the cecum mucosa and ileocecal valve with a black color, with superficial ulceration of the proximal limit and sharp transition to normal mucosa. Biopsies of the cecum confirmed severe ischemic colitis with necrosis. Due to the absence of complications and high surgical risk, the patient was treated conservatively with fluids and antibiotics, resulting in a favorable outcome and hospital discharge.

Safety of two-dose schedule of COVID-19 adsorbed inactivated vaccine (CoronaVac; Sinovac/Butantan) and heterologous additional doses of mRNA BNT162b2 (Pfizer/BioNTech) in immunocompromised and immunocompetent individuals.

Immunocompromised individuals were considered high-risk for severe disease due to SARS COV-2 infection. This study aimed to describe the safety of two doses of COVID-19 adsorbed inactivated vaccine (CoronaVac; Sinovac/Butantan), followed by additional doses of mRNA BNT162b2 (Pfizer/BioNTech) in immunocompromised (IC) adults, compared to immunocompetent/healthy (H) individuals. This phase 4, multicenter, open label study included solid organ transplant and hematopoietic stem cell transplant recipients, cancer patients and people with inborn errors of immunity with defects in antibody production, rheumatic, end-stage chronic kidney or liver disease, who were enrolled in the IC group. Participants received two doses of CoronaVac and additional doses of mRNA BNT162b2. Adverse reactions (AR) data were collected within seven days after each vaccination. Serious adverse events and of special interest (AESI) were monitored throughout the study. We included 241 immunocompromised and 100 immunocompetent subjects. Arthralgia, fatigue, myalgia, and nausea were more frequent in the IC group after CoronaVac. Following the first additional dose of mRNA BNT162, pain, induration, and tenderness at injection site, fatigue and myalgia were more frequent in the H group. A heart transplant recipient had a graft rejection temporally associated with the second CoronaVac dose, but there was no literature evidence of causal association. Four cases of AESI were considered related to the vaccine: three erythema multiforme after CoronaVac, all in IC participants, and one paresthesia after mRNA, in a H participant. Our findings were comparable to other studies that evaluated the safety of COVID-19 vaccines in different immunocompromised populations. Both vaccines were safe for immunocompromised participants.

"YouTube" for Surgical Training and Education in Donor Nephrectomy: Friend or Foe?

The COVID-19 pandemic has accelerated the shift toward e-learning and online education in surgical training. With the increasing prevalence of end-stage chronic kidney disease, kidney transplantation is in high demand. Donor safety is crucial in nephrectomy procedures, highlighting the importance of effective training. This study evaluates the quality and effectiveness of YouTube videos focusing on laparoscopic and robotic donor nephrectomy for surgical education. On October 24, 2023, searches on YouTube for "laparoscopic live donor nephrectomy" and "robotic live donor nephrectomy" returned 121 videos, with 63 included in the study. Popularity was evaluated using the Video Power Index (VPI), while reliability and quality were assessed using the LAP-VEGaS Video Assessment Tool and Journal of the American Medical Association (JAMA) benchmark criteria. Additionally, a structured descriptive tool called the "Live Donor Nephrectomy Completeness (LDNC)" was created to evaluate the completeness and educational value of procedural technical steps. Out of 63 videos reviewed, laparoscopic surgical procedures were depicted in 71.4% of them, while robotic approaches were shown in 28.6%. Academic backgrounds were associated with 54% of the videos, and individual physician backgrounds with 46%. Mean scores were LAP-VEGaS 9.79 ± 3.87, VPI 6.32 ± 3.31, and LDNC 9.68 ± 1.97. JAMA scores varied, with 34.9% receiving 1 point, 34.9% receiving 2 points, 17.5% receiving 3 points, and 12.7% receiving 4 points. Academic videos scored significantly higher in LAP-VEGaS and LDNC (all p < .01). While LAP-VEGaS, VPI, and LDNC scores correlated significantly (all p < .05), no correlation was found between JAMA score and other scoring systems. Videos with more clicks and likes showed significantly better scores across all measures (all p < .05). Amidst the challenges posed by the pandemic on surgical education, YouTube has emerged as a valuable resource for learning about laparoscopic and robotic donor nephrectomy for living kidney donation. However, the quality and reliability of these videos vary greatly, and many lack thorough reviews, leading to incomplete information. To enhance their educational value, it's proposed that videos undergo professional evaluation before publication and adhere to standardized, structured, and validated scoring systems, ensuring logical structure and improved quality.

Conscious Nutrition to Improve Survival Prognosis of Donor Kidney Recipients: A Narrative Review.

Kidney transplantation is the optimal treatment for end-stage chronic kidney disease, increasing survival rates and improving quality of life. Diet affects patient weight and well-being, can trigger certain diseases, and influences post-surgery outcomes. The purpose of the study was to investigate dietary strategies in patients with chronic kidney disease, in early and long-term donor kidney recipients, and to formulate specific nutritional recommendations. For this purpose, a narrative review of the available information in both the Republic of Kazakhstan and the world's scientific literature over the last 10 years was carried out. The following evidence-based resources were used: Scopus, PubMed, Embase, Cochrane Library, and Web of Knowledge. The study provides the latest statistical data on kidney transplantation and risk factors, and a comparative analysis between countries. Existing data on basic nutrition and the possibility of using it after transplantation are examined in detail. In addition, the recommendations for daily intake of salt, potassium, sodium, vitamin D, and calcium were analyzed. The energy value of the diet and its association with overweight, obesity, and the development of diabetes mellitus were studied. Using DASH (Dietary Approaches to Stop Hypertension) and low-protein diets as examples, the potential risks and their applicability for this patient category are analyzed. The article's materials and conclusions can serve as a training manual for nephrologists, therapists, and surgeons.

Impact on fluid balance of an optimized restrictive strategy targeting non-resuscitative fluids in intensive care patients with septic shock: a single-blind, multicenter, randomized, controlled, pilot study

BackgroundIn septic shock, the classic fluid resuscitation strategy can lead to a potentially harmful positive fluid balance. This multicenter, randomized, single-blind, parallel, controlled pilot study assessed the effectiveness of a restrictive fluid strategy aiming to limit daily volume.MethodsPatients 18–85 years’ old admitted to the ICU department of three French hospitals were eligible for inclusion if they had septic shock and were in the first 24 h of vasopressor infusion. Exclusion criteria were acute kidney injury requiring renal replacement therapy, end stage chronic kidney disease, and severe malnutrition. Patients were electronically randomized 1:1 to either an optimized fluid restriction (reducing fluid intake as much as possible in terms of maintenance fluids and fluids for drug dilution during the first 7 days) or standard fluid strategy. The primary outcome was cumulative fluid balance (ml/kg) in the first 5 days. Patients and statisticians were blinded to group arm, but not clinicians.ResultsBetween September 2021 and February 2023, 1201 patients were screened and 50 included, with two in the control group withdrawing, thus 48 patients were analyzed (24 in each group). In the first 5 days, the optimized restrictive strategy and control groups received 89.7 (IQR 35; 128.9) and 114.3 (IQR 78.8; 168.5) ml/kg of fluid, respectively (mean difference: 35.9 ml/kg [0.0; 71.8], p = 0.0506). After 5 days, the median cumulative fluid balance was 6.9 (IQR − 13.7; 52.1) and 35.0 (IQR − 7.9; 40.2) ml/kg in the optimized restrictive strategy and control groups, respectively (absolute difference 13.2 [95%CI − 15.2; 41.6], p = 0.42). After 28 days, mortality and the numbers of days alive without life support were similar between groups. The main adverse events were severe hypernatremia in 1 and 2 patients in the fluid restriction strategy and control groups, respectively, and acute kidney injury KDIGO 3 in 4 and 7 patients in the fluid restriction strategy and control groups, respectively.ConclusionsIn ICU patients with septic shock, an optimized restrictive fluid strategy targeting hidden fluid intakes did not reduce the overall fluid balance at day 5.Trial registration ClinicalTrials.gov identifier NCT04947904, registered on 1 July 2021.Graphical

Skin autofluorescence as part of the comprehensive assessment of clinical and metabolic status of patients with end-stage chronic kidney disease

BACKGROUND: Chronic kidney disease (CKD) is a common end-stage disease requiring kidney transplantation or dialysis, which main type is program hemodialysis (PHD). These high-cost technologies of renal replacement therapy have significantly improved over recent decades, but the quality of life remains low and mortality is still high, especially in patients receiving PHD. Currently, a number of parameters associated with poor prognosis have been identified, including skin autofluorescence (SAF), an affordable method to detect glycation end products (glycotoxins) in tissues, which claims to be an integral biomarker. AIM: To assess relationship of SAF with clinical and metabolic status parameters in patients receiving renal replacement therapy. MATERIALS AND METHODS: The study included 88 patients receiving PHD and 27 transplanted kidney recipients (TKR). The measurements were performed using the original SAF reader. RESULTS: SAF was significantly higher in TKR and patients receiving PHD. A universal, pronounced relationship of SAF with age and smoking was found in the control, PHD, and TKR groups. Models of SAF determinants in each studied group were proposed. SAF was associated with malnutrition stages (by NRI; r=−0.39; p 0.001), the Charlson comorbidity index (r=0.60, p 0.0001), and inflammatory activity based on C-reactive protein in the PHD group (r=0.32, p 0.01). CONCLUSION: Models of SAF determinants in each studied group were proposed. Furthermore, highly significant direct correlations with left ventricular hypertrophy and its negative ejection fraction were established in this group. These facts suggest that SAF is an integral parameter of cardiac remodeling and metabolic profile, primarily in patients receiving PHD, which promotes it as a prognostic parameter.

Assessment of Trace elements (Zinc, Copper) in Iraqi Patients with Chronic Kidney Disease on Dialysis

Background: In the context of insufficient healthcare accessibility for a substantial segment of the global populace, chronic kidney disease (CKD) has emerged as a significant contributor to mortality, ranked subsequent to cardiovascular disease and neoplasia, demonstrating a notable increase over the preceding two decades. This rising burden of CKD is further exacerbated by a deficient understanding of its underlying pathogenesis. Therefore, it was important to study all the variables in the human body that contribute to monitoring the patient's condition or preventing the patient's condition from deteriorating. In this study, we highlighted some trace elements (zinc and copper), and monitored the change in these elements between patients and healthy people. We indicated the possibility of monitoring the results of tests for these elements to predict the condition of patients from the first stage to the final stages of chronic renal failure patients on dialysis. purpose: To assess the trace elements (zinc, copper) in Chronic kidney disease patients compared with healthy control. Methods: A total forty (40) patient with chronic kidney disease were studied among them twenty (20) female and twenty (20) male patients and forty (40) healthy as control of them were eighteen (18) females and twenty-two (22) males. Their ages (patients and controls) were ranged from (18 – 70). Blood samples were collected from patients and control to evaluate serum levels of serum trace elements (zinc, copper) and evaluate the routine markers (urea, creatinine, Alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase) and this was done by spectrophotometry. Results The Zinc levels in the patients (80.69±51.30 μg/dl) were lower than in the control group (97.42±38.61 μg/dl) (p=0.10773) and The Copper levels in the patients are significantly higher (116.33±71.20 μg/dl) than in the control group (74.77±46.16 μg/dl) (p=0.00304). while The Alanine Aminotransferase and Aspartate Aminotransferase levels in the patients are lower than in the control group, but the difference is not statistically significant for ALT (p=0.13235) and is significant for AST (p=0.02982). the Alkaline Phosphatase, Urea, and Serum Creatinine levels in the patients were all significantly higher than in the control group (p&lt;0.00001 for all). Conclusion: A notable elevation in alkaline phosphatase and copper levels is observed in chronic kidney disease patients, alongside a modest decrease in serum zinc in those with end-stage chronic kidney disease compared to healthy individuals, indicating these biomarkers' potential diagnostic utility in advanced stages of the disease. The correlation between AST/ALT and CKD progression highlights the impact of liver enzyme alterations during chronic kidney disease.