Non-diabetic Hemodialysis Patients Research Articles

Increased Systemic Levels of Centrally Acting B-Type Natriuretic Peptide Are Associated with Chronic Itch of Different Types

B-Type natriuretic peptide (BNP) is an itch-selective neuropeptide that was shown to play a role in both histaminergic and non-histaminergic itch in mice. It was also shown that elevated serum BNP is linked to increased pruritus in non-diabetic hemodialysis patients. This study examined plasma BNP levels of 77 patients and N-Terminal pro-BNP (NT-proBNP) levels of 33 patients with differing types of chronic itch to see if BNP and NT-proBNP levels can correlate with itch severity. Plasma BNP and NT-proBNP levels of all itch patients correlated to itch NRS, and in particular for patients with Chronic Pruritus of Unknown Origin (CPUO). Based on this clinical observation, this study further showed that increasing pathophysiological levels of BNP in mice by IV or osmotic pump induced significant scratching. Additionally, pharmacological and ablation strategies determined that BNP acts centrally by activating the natriuretic peptide receptor A (NPRA) in the dorsal horn of the spinal cord. These data support that BNP and NT-proBNP levels are associated with chronic itch and may be used in clinical setting.

Status and trends in epidemiologic characteristics of diabetic end-stage renal disease: an analysis of the 2021 Korean Renal Data System.

Korean Renal Data System (KORDS) is a nationwide end-stage renal disease (ESRD) registry database operated by the Korean Society of Nephrology (KSN). Diabetes mellitus is currently the leading cause of ESRD in Korea; this article provides an update on the trends and characteristics of diabetic ESRD patients. The KORDS Committee of KSN collects data on dialysis centers and patients through an online registry program. Here, we analyzed the status and trends in characteristics of diabetic chronic kidney disease stage 5D (CKD 5D) patients using data from 2001 to 2021. In 2021, the dialysis adequacy of hemodialysis (HD) was lower in diabetic CKD 5D patients than in nondiabetic CKD 5D patients, while that of peritoneal dialysis (PD) was similar. Diabetic CKD 5D patients had a higher proportion of cardiac and vascular diseases and were more frequently admitted to hospitals than nondiabetic CKD 5D patients, and the leading cause of death was cardiac disease. From 2001 to 2020, diabetic CKD 5D patients had a higher mortality rate than nondiabetic CKD 5D patients, but in 2021 this trend was reversed. Diabetic PD patients had the highest mortality rate over 20 years. The mortality rate of diabetic HD patients was higher than that of nondiabetic HD patients until 2019 but became lower starting in 2020. There was a decreasing trend in mortality rate in diabetic CKD 5D patients, but cardiac and vascular diseases were still prevalent in diabetic CKD 5D patients with frequent admissions to hospitals. More specialized care is needed to improve the clinical outcomes of diabetic CKD 5D patients.

Hypoglycemia and Mortality Risk in Incident Hemodialysis Patients

BackgroundHypoglycemia is a frequent occurrence in chronic kidney disease (CKD) patients due to alterations in glucose and insulin metabolism. However, there are sparse data examining the predictors and clinical implications of hypoglycemia including mortality risk among incident hemodialysis patients. MethodsAmong 58,304 incident hemodialysis patients receiving care from a large national dialysis organization over 2007-2011, we examined clinical characteristics associated with risk of hypoglycemia, defined as a blood glucose concentration <70 mg/dL, in the first year of dialysis using expanded case-mix+laboratory logistic regression models. We then examined the association between hypoglycemia during the first year of dialysis with all-cause mortality using expanded case-mix+laboratory Cox models. ResultsIn the first year of dialysis, hypoglycemia was observed among 16.8% of diabetic and 6.9% of non-diabetic incident hemodialysis patients. In adjusted logistic regression models, clinical characteristics associated with hypoglycemia included younger age, female sex, African-American race, presence of a central venous catheter, lower residual renal function, and longer dialysis session length. In the overall cohort, patients who experienced hypoglycemia had a higher risk of all-cause mortality risk (reference: absence of hypoglycemia): adjusted HR (95%CI) 1.08 (1.04, 1.13). In stratified analyses, hypoglycemia was also associated with higher mortality risk in the diabetic and non-diabetic subgroups: adjusted HRs (95% CI’s) 1.08 (1.04-1.13), and 1.17 (0.94-1.45), respectively. ConclusionsHypoglycemia was a frequent occurrence among both diabetic and non-diabetic hemodialysis patients, and was associated with higher mortality risk. Further studies are needed to identify approaches that reduce hypoglycemia risk in the hemodialysis population.

Serum fetuin-A in diabetic and nondiabetic hemodialysis patients

Serum fetuin-A in diabetic and nondiabetic hemodialysis patients

Phenotypic and genotypic characterization of virulence markers and antifungal susceptibility of oral Candida species from diabetic and non-diabetic hemodialysis patients

BackgroundPatients with chronic kidney disease undergoing hemodialysis are often colonized by Candida species with high possibility of fungal infections. The purposes of this study were to determine the prevalence of Candida species, evaluate antifungal susceptibility profile, biofilm formation, proteinase and phospholipase activities, and the frequency of virulence genes in the Candida species isolated from the oral mucosa of hemodialysis diabetic (DM) and non-diabetic (non-DM) patients.MethodsThis study identified several species of Candida isolated from 69 DM and 58 non-DM patients on hemodialysis using phenotypic methods and PCR–RFLP technique. The identification of C. albicans and C. glabrata complex was performed by HWP1 gene and four oligonucleotides (UNI-5.8S, GLA-f, BRA-f, and NIV-f), respectively. Antifungal susceptibility to amphotericin B, fluconazole, itraconazole, voriconazole, and caspofungin was assessed according to CLSI M27-A3/S4. The biomass, metabolic activity of biofilm, proteinase (Prz), phospholipase (Pz), and molecular study for virulence genes were assessed using crystal violet, XTT assay, agar-based hydrolytic enzyme, and PCR technique, respectively.ResultsCandida prevalence was 44.9% with 47.8% and 41.4% among DM and non-DM patients, respectively (P = .045). The species identified were C. albicans (49.5%), C. glabrata (16.5%), C. tropicalis (12%), C. kefyr (8.8%), C. parapsilosis (6.6%), C. dubliniensis (3.3%), and C. lusitaniae (3.3%). The antifungal susceptibility profile showed that all Candida isolates were sensitive to amphotericin B, itraconazole, voriconazole, and caspofungin whereas fluconazole resistance was observed in 6.3% (MIC ≥ 64 μg/mL) of C. albicans and 6.6% of C. glabrata (MIC ≥ 64 μg/mL). The susceptible- dose-dependent rate was found in 10.5% of C. albicans. The Prz values of C. albicans ranged from 0.37 to 0.66 for the DM and 0.44–0.73 for the non-DM group (P < 0.05). The non-albicans Candida (NAC) species produced higher degree of biomass and metabolic activity compared to C. albicans (P < 0.05). Furthermore, significant (p < 0.05) correlations were detected between the biofilm formation with Prz values and fluconazole MICs. The most detected virulence factors were ALS3 and Sap5.ConclusionsThese results showed the importance of prevalence of NAC species in hemodialysis patients. Investigating antifungal susceptibility profile made a better understanding of the role of virulence markers in the pathogenesis of Candida strains.

Association between zinc deficiency and aorta stiffness in non-diabetic hemodialysis patients.

Zinc deficiency (Zn < 60 μg/dL) is known to play an important role for vascular calcification. However, little data is available regarding the association between zinc deficiency and aorta stiffness in dialysis patients. Thus, we studied the relationship between zinc deficiency and aorta stiffness in non-diabetic hemodialysis (HD) patients. Of 150 patients receiving maintenance HD at our hospital, we included 79 non-diabetic HD patients (age: 70±11 years, 49 men) after excluding 71 diabetic HD patients. Zinc deficiency was defined as Zn <60 μg/dL during pre-HD blood sampling. The association between zinc deficiency and aorta stiffness was analyzed. Aorta stiffness was evaluated as brachial-ankle pulse wave velocity (baPWV). Other surrogate markers for cardiovascular complications were also measured. The zinc deficiency group (ZD group) included 45 patients (57.0%). Compared to the zinc non-deficiency group (ZND group), patients with ZD group were significantly older, higher levels of CRP and hypoalbuminemia. Moreover, they had significantly higher levels of baPWV, and lower levels of ankle-brachial pressure index (ABI) (p<0.05). After adjusting for hypoalbuminemia, and CRP, multivariate analysis showed that age and zinc level were independent predictors of baPWV. The study suggested that zinc deficiency may be an independent risk factor for aorta stiffness, even after adjusting for malnutrition and inflammation.

Survey of non-alcoholic steatohepatitis in non-diabetic Haemodialysis patients in Beni-Suef Governorate

Survey of non-alcoholic steatohepatitis in non-diabetic Haemodialysis patients in Beni-Suef Governorate

Comparison of Hearing Abnormalities in Non-Diabetic and Diabetic End-Stage Renal Disease Patients Undergoing Hemodialysis

Background and Aim: Hearing loss is a highly prevalent symptom in patients with chronic kidney diseases (CKD). Comorbidities such as Diabetes Mellitus is known as the most common cause of CKD and a significant risk factor for sensorineural hearing loss (SNHL). The aim of this study was to compare SNHL among diabetic with non-diabetic hemodialysis patients.&#x0D; Methods: In this study, 33 diabetic patients on hemodialysis were selected from Hami center, Arak, Iran. Non-diabetic subjects were 31 hemodialysis patients without diabetes were matched for age, duration of CKD and hemodialysis. Data were obtained via questionnaire, patients’ files, physical examination, otoscopy and tympanometry. Hearing was analyzed using pure-tone audiometry for both groups.&#x0D; Results: In the study, 66.2% of diabetic patients and 52.1% of non-diabetic subjects had SNHL. Results showed that diabetic patient has 1.3 times more likely to have hearing impairment. This difference was not statistically significant. Bilateral mild SNHL was the most prevalent in both groups. No significant difference was reported in SNHL prevalence, mean thresholds of hearing and ear laterality between the groups. Gender and age had a significant effect on hearing loss after adjusting covariables. No significant association was found between diabetes and hearing loss.&#x0D; Conclusion: SNHL was more common in hemodialysis patients with diabetes. Patients with diabetes had poorer hearing thresholds compared to non-diabetic group, with no significant difference between groups. The periodical assessment of hearing and extending audiological care in this high-risk population is recommended due to long-term irreversible symptoms of the disease.&#x0D; Keywords: Diabetes mellitus; hearing loss; end-stage renal disease

Impact of parathyroidectomy among nondiabetic hemodialysis patients with severe hyperparathyroidism

Background Parathyroidectomy (PTX) is a treatment for hyperparathyroidism (HPT) and has uncertain risks and benefits. The aim of this study was to evaluate the effect of PTX versus nonoperative treatment among nondiabetic hemodialysis patients. Methods A retrospective matched cohort study was performed. Each PTX patient was matched with one patient who had severe HPT but rejected PTX. The patients were matched by sex, birth date, date of first dialysis, nondiabetic status, and left ventricular ejection fraction. The serum markers, survival, main adverse cardiovascular and cerebrovascular event (MACCE) rates, and hospitalization were compared between the PTX patients and matched non-PTX patients. Results There were 1143 patients at our center in the Chinese National Renal Data System (CNRDS) between 2010 and 2020. Of these, 75 PTX patients were matched with 75 non-PTX patients. Rapid decreases in the mean intact parathyroid hormone, calcium and phosphorus concentrations, and a gradual increase in hemoglobin concentration were observed in the PTX group. The mortality was 2.9 per 100 patient-years in the PTX group and 10.9 per 100 patient-years in the non-PTX group (p < 0.001). Compared with non-PTX patients, PTX patients had an adjusted HR for death of 0.236 (95% CI 0.108–0.518). The cumulative MACCE rates were 6.7 per 100 patient-years in the PTX group and 15.2 per 100 patient-years in the non-PTX group (p < 0.001). The adjusted HR of the occurrence of first MACCE for PTX patients compared with non-PTX patients was 0.524 (95% CI 0.279-0.982). The cumulative hospitalization rates were 50.3 per 100 patient-years in the PTX group and 66.5 per 100 patient-years in the matched non-PTX group (p < 0.001). Conclusions Compared with non-PTX patients, PTX was associated with an improvement in the biochemical measures and patient-level outcomes in nondiabetic hemodialysis patients with severe HPT.

THE SPECIFICS OF HEMODIALYSIS IN DIABETICS. EASTERN ALGERIAN EXPERIENCE

Objective: The management of diabetics on hemodialysis is particularly difficult due to frequent hypoglycaemia and significant inter and perdialytic glycemic variability that is difficult to predict. The aim of our study is to describe the clinical-biological profile and to assess the cardiovascular risk of diabetics undergoing chronic hemodialysis and to compare them to non-diabetic hemodialysis patients. Design and method: This cross-sectional, descriptive and analytical study was carried out between January 01 and December 31, 2018, involving 309 hemodialysis patients spread over 4 centers The data were collected prospectively then compiled and analyzed by the SPSS Version 10 software The FRAMINGHAM RISK SCORE has been used to assess cardiovascular risk in all hemodialysis patients Results: The survey involved 309 hemodialysis patients, including 83 diabetics, for a prevalence of 27% The average age 53 ± 10.2 years. The sex ratio is 1.5. 50% of diabetic hemodialysis patients retained residual diuresis against 32% in non-diabetics. In the group of diabetics, we noted more hypertension (70% versus 38% non-diabetics P 0.004), more intradialytic hypoglycemia (15% versus 3% non-diabetics P 0.007), initially vascular exhaustion was found. in 4 diabetics versus 2 non-diabetics. 70% of diabetics with anuria had postdialytic hyperglycemia. The study found a statistically significant difference between the different levels of cardiovascular risk according to the diabetic status. Conclusions: There are many challenges in the management of diabetics on hemodialysis, both to optimize glycemic control according to an individualized target, and to coordinate comprehensive and effective care.

Comparison of COVID-19 Inactivated Virus Vaccine Immunogenicity Between Healthy Individuals and Patients on Hemodialysis: A Single-Center Study From Pakistan.

IntroductionThis study compares the immune response after coronavirus disease 2019 (COVID-19) inactivated virus vaccine between healthy individuals (HI) and patients on hemodialysis (HD).MethodsIn this cross-sectional, comparative study, the presence or absence of immunoglobulin G (IgG) anti-S antibody and IgG anti-S antibody titer was compared between HI, and patients on HD after two doses of COVID-19 vaccine.ResultsA total of 81 participants, 50 (61.7%) HD patients and 31 (38.3%) HI, were studied. The mean age was 52.9±12 in HD patients and 42±12.4 in HI. Vaccination responder rates were 80.6% in HI and 72% in HD patients after the first dose (p=0.38) and 93.5% in HI and 94% in HD at the third week of the second dose of the vaccine (p=0.93). The mean IgG antibody titer was 156.3±113.8 in HI and 143.4 ± 117.8 in HD patients (p=0.538) after the first dose and 186.7 ± 97.9 in HI and 180.6 ± 105.8 in HD patients (p=0.552) at three weeks of the second dose. No statistically significant difference was found in antibody titer with respect to gender, age, vaccine (BBIBP-CorV or Conovac), and hypertension. Diabetic HD patients had a lower antibody titer than non-diabetic HD patients (p=0.03) while participants who had a history of COVID-19 infection had a higher IgG titer (p = 0.001). The levels of IgG titer in the same patient increased, corresponding to the doses of vaccine (p <0.001). No HD patient developed COVID-19 infection till the third week of vaccination.ConclusionThis study demonstrates a similar humoral response after COVID-19 inactivated virus vaccination in HD patients and HI. The response was lower among diabetic patients on HD and better in those with previous COVID-19 infection.

Clinical prognostic role of bioimpedance phase angle in diabetic and non-diabetic hemodialysis patients.

Bioelectrical-impedance analysis (BIA) is frequently used to estimate dry weight in hemodialysis (HD) patients. However, the clinical prognostic significance of BIA indicators is unclear. As a nutritional index, low phase angle (PA) might be an independent risk factor for predicting death in multiple chronic diseases. We performed this study to find relative influence factors of PA and other clinical prognostic significance. The study involved 87 HD patients, 33 of whom were diabetic and 54 of whom were not. We measured body composition index, body water index and nutritional indicators and collected biochemical criteria. Then, we statistically analyzed the associations of these indices. After 1 year of follow- up, we recorded death, heart failure, hospitalization, cerebrovascular and cardiovascular events and other clinical outcomes. We found a significant difference between the two groups in visceral-fat area, extracellular water/total body water (ECW/TBW) ratio and PA value. Two factors were negatively associated with PA: ECW/TBW ratio and HCO3- before HD. At 1 year, we noted that PA was associated with events such as heart failure or hospitalization. By further stratification and multivariate analysis adjusting for age, sex and months of dialysis, we found that low PA was an independent predictor of heart failure for diabetic HD patients. PA value was lower in Diabetic nephropathy (DN) HD patients, than that in non-DN HD patients. PA was mainly negatively associated with ECW/TBW ratio. It is a useful index for predicting heart failure in diabetic HD patients.

Lipid profile of diabetic and non-diabetic hemodialysis patients at the Donka hemodialysis center

The objectives were to determine the frequency of dyslipidemia in hemodialysis patients and to identify the main lipid abnormalities encountered in hemodialysis patients (diabetics and non-diabetics). A descriptive cross-sectional study lasting 6 months. From 07/01/2019 to 12/31/2019. During the study period, we have Included all hemodialysis patients(diabetics and no diabetics) who had lipid status at the Donka Hemodialysis Center of Guinea. We registered 164 hemodialysis patients, 99 agreed to participate in our study, a participation rate of 60.3% including 18 diabetics and 81 non-diabetics. The prevalence of diabetes in hemodialysis patients was 18.2% compared to 81.8% in non-diabetics. The mean age of our patients was 46.01 ± 14.18 with extremes ranging from [18–71 years]. The male sex was the most affected with a sex ratio of 1.3. The majority of our patients came from the urban area with a frequency of 93.93%. Among diabetics, the most represented profession was civil servants, i.e. 61.11%, while among non-diabetics 32.09% were housewives. The duration in hemodialysis was 32.72 months on average with extremes of 6 to 180 months. The alterations in the lipid balance observed were: hypertriglyceridemia; hypoHDLemia which are respectively 71.71%; 68.68%. The total cholesterol/HDL-cholesterol ratio in order to assess the arterial and especially coronary risk we found a ratio greater than or equal to 4.8 in 10% of our patients, i.e. 16.7% in diabetics and 8.6% in non-diabetics. The mortality rate in our study was 14.14% of which 22.4% in diabetics and 12.3% in non-diabetics. Our study shows that disturbances in the lipid balance remain high in hemodialysis patients; favored by a history of diabetes and/or arterial hypertension and exposing them to arterial risk, especially coronary artery.

Evaluation of demographic and clinical risk factors for high interdialytic weight gain.

Xerostomia and hyposalivation are highly prevalent in hemodialysis (HD) patients and this is effective in increased fluid intake. The aim of this study is to determine the demographic and clinical risk factors associated with high interdialytic weight gain (IDWG) in nondiabetic HD patients. In total, 52 eligible HD patients were recruited in this cross-sectional study. Patients were divided into two groups according to % IDWG: Group 1: High IDWG (≥3%) and Group 2: normal IDWG (<3%). Plasma osmolarity (POsm), unstimulated salivary flow rate (USFR), xerostomia inventory (XI), and dialysis thirst inventory (DTI) were evaluated. The mean age of the patients was 53.7 ± 15.7 years. The prevalence of xerostomia was 53.8%, and hyposalivation was in 40.3% in the patients. High IDWG was positively correlated with XI and DTI while it was negatively correlated with POsm and USFR. The area under the receiver-operating characteristics curve for POsm for high IDWG was 0.661, with sensitivity of 63.8% and specificity of 72.7% for a cut-off point of 297.4mOsm/L. Logistic regression analysis showed that advanced age odds ratio (OR: 1.215, p= 0.019), pill burden (OR: 1.162, p= 0.031), C-reactive protein (CRP; OR: 1.308, p= 0.042), and low POsm (OR: 0.768, p= 0.046) were independently related to high IDWG. The prevalence of xerostomia and thirst was higher in HD patients with high IDWG compared to the normal IDWG group. Age, CRP, low POsm, and pill burden were independently associated with high IDWG.

Biomarkers of Glyco-Metabolic Control in Hemodialysis Patients: Glycated Hemoglobin vs. Glycated Albumin.

Background and Objectives: Glycated hemoglobin (HbA1c) dosage is considered the gold standard in glycol-metabolic monitoring, but it presents limits, which can underestimate the glycemia trend. In this regard, it was introduced the glycated albumin (GA). The aim of the study is to verify the predictivity of the GA compared to HbA1c in identifying glyco-metabolic alterations in non-diabetic and diabetic hemodialysis (HD) patients. Materials and Methods: For this purpose, we conducted a multicenter study involving one analysis laboratory and six dialysis centers in the Lazio region (Rome, Italy). Both diabetic and non-diabetic HD patients represent the study population, and the protocol included five time points. Results: The analyzed data highlighted the ability of GA to predict changes in glycemic metabolism in HD patients, and GA values are not significantly influenced, like HbA1c, by dialysis therapy itself and by comorbidities of the uremic state, such as normochromic and normocytic anemia. Thus, GA seems to reflect early glyco-metabolic alterations, both in patients with a previous diagnosis of diabetes and in subjects without diabetes mellitus. As part of this study, we analyzed two HD patients (one diabetic and one non-diabetic) in which GA was more predictive of glycol-metabolic alterations compared to HbA1c. Our study confirms the need to compare classical biomarkers used for the monitoring of glyco-metabolic alterations with new ones, likely more reliable and effective in specific subgroups of patients in which the classic biomarkers can be influenced by the preexisting pathological conditions. Conclusions: In conclusion, our evidence highlights that in uremic patients, GA shows a better ability to predict glyco-metabolic alterations allowing both an earlier diagnosis of DM and a prompt modulation of the hypoglycemic therapy, thus improving the clinical management of these patients.

Dextrose solution for priming and rinsing the extracorporeal circuit in hemodialysis patients: A prospective pilot study.

Introduction:Excess sodium intake and consequent volume overload are major clinical problems in hemodialysis (HD) contributing to adverse outcomes. Saline used for priming and rinsing of the extracorporeal circuit is a potentially underappreciated source of intradialytic sodium gain. We aimed to examine the feasibility and clinical effects of replacing saline as the priming and rinsing fluid by a 5% dextrose solution.Materials and methods:We enrolled non-diabetic and anuric stable HD patients. First, the extracorporeal circuit was primed and rinsed with approximately 200–250 mL of isotonic saline during 4 weeks (Phase 1), subsequently a similar volume of a 5% dextrose solution replaced the saline for another 4 weeks (Phase 2), followed by another 4 weeks of saline (Phase 3). We collected data on interdialytic weight gain (IDWG), pre- and post-dialysis blood pressure, intradialytic symptoms, and thirst.Results:Seventeen chronic HD patients (11 males, age 54.1 ± 18.7 years) completed the study. The average priming and rinsing volumes were 236.7 ± 77.5 and 245.0 ± 91.8 mL respectively. The mean IDWG did not significantly change (2.52 ± 0.88 kg in Phase 1; 2.28 ± 0.70 kg in Phase 2; and 2.51 ± 1.2 kg in Phase 3). No differences in blood pressures, intradialytic symptoms or thirst were observed.Conclusions:Replacing saline by 5% dextrose for priming and rinsing is feasible in stable HD patients and may reduce intradialytic sodium loading. A non-significant trend toward a lower IDWG was observed when 5% dextrose was used. Prospective studies with a larger sample size and longer follow-up are needed to gain further insight into the possible effects of using alternate priming and rinsing solutions lowering intradialytic sodium loading.Trial registration:Identifier NCT01168947 (ClinicalTrials.gov).

Association between anemia and mortality in hemodialysis patients is modified by the presence of diabetes.

The prevalence and severity of anemia differ between diabetic and non-diabetic patients. We investigated whether the effect of hemoglobin (Hb) on patient outcome was affected by the presence or absence of diabetes among Japanese patients receiving chronic hemodialysis (HD). We enrolled 149,308 patients from a nationwide dialysis registry in Japan at the end of 2012 (mean age, 67.6 ± 12.3years; male, 61.7%; diabetes, 43.5%; median dialysis duration, 65months) who underwent three HD sessions weekly. One-year all-cause and cardiovascular (CV) mortality were assessed using Cox regression analysis and competing-risks regression analysis. We used multiple imputation to deal with missing covariate data. Baseline Hb and serum ferritin levels were independently associated with all-cause and CV mortality. In non-diabetic patients, a significantly higher risk for all-cause mortality compared to the reference group (10 to 11g/dL) was observed in patients with Hb < 8g/dL (hazard ratio (HR): 1.266; 95% confidence interval (CI) 1.097-1.460) and 8 to 9g/dL(HR: 1.153; 95% CI 1.030-1.290). On the other hand, diabetic HD patients in the same Hb category group did not have increased risk of all-cause mortality. We found that non-diabetic HD patients had an increased risk of all-cause mortality if they had lower Hb levels, whereas the effect of Hb levels on mortality was attenuated in diabetic HD patients. These data suggest that the association between Hb levels and mortality rate could be different between diabetic and non-diabetic HD patients.

Nasal manifestations in patients with chronic renal failure on hemodialysis

Background Patients with end-stagerenal disease (ESRD) on regular hemodialysis (HD) show various otolaryngological manifestations owing to uremic toxins and electrolyte imbalance. Previous studies have reported epistaxis as the most common ENT manifestations of ESRD on HD as explained by bleeding tendency related to uremia or HD itself. Nasal crustation, septal perforation, and olfactory dysfunction were also observed in HD patients. Objective To evaluate the frequency of different nasal manifestations among nondiabetic prevalent HD patients. Patients and methods A cross-sectional study was conducted in Ain Shams University Hospital from March 2019 till September 2019. It included 68 eligible nondiabetic patients with ESRD on regular HD more than 6 m. All patients were subjected to full history and clinical examination. CT nose and sinus was done only if indicated. Complete blood count and routine chemistry (blood urea nitrogen, serum creatinine, urea reduction ratio, calcium, phosphorus, parathyroid hormone, and iron profile) were done. Results Most patients did not give a past history of epistaxis (94.1%). Overall, 44.1% of the patients experienced dry nasal mucosa and pale inferior turbinates, and 10.3% of the patients had congested nasal mucosa. Crustations were founded in 7.4% of the patients, although they were found in nearly double percentage in nasal septum (14.7%). The nasal septum deviation and ulceration were found in 2.9% each. Only one (1.5%) patient had nasal septum perforation. The mean level of hemoglobin (g/dl) concentration was 10.4 (range, 6.8–15 g/dl). Conclusion Modern adequate HD techniques have reduced epistaxis in patients with ESRD. The most common ENT manifestations were dry nasal mucosa and pale inferior nasal turbinate and to a lesser extent crustations on both nasal septum and inferior nasal turbinate.

Relationship of serum irisin levels and various demographic and biochemical factors in non-diabetic hemodialysis patients

Introduction: Irisin is a myokine secreted from the skeletal muscle. Preliminary studies showed that the serum irisin level was decreased in patients with chronic kidney disease (CKD), particularly in hemodialysis patients. Objectives: This study aimed to examine the relationship between serum irisin level and different demographic and biochemical factors in non-diabetic hemodialysis patients. Patients and Methods: This study was conducted on 61 non-diabetic stable hemodialysis patients. Serum level of irisin was measured by ELISA method. Demographic information was recorded for all subjects. In addition, biochemical factors were assessed using standard methods. Results: In this study serum irisin level was 8.15±4.24 ng/mL. There were positive correlations of serum irisin with gender (P=0.014) (higher serum value of irisin in males) and hemodialysis doses (r=0.32, P=0.01). Additionally, a negative correlation of serum irisin with body mass index (BMI) was detected (r= 0.26, P=0.036). Conclusion: The positive correlation of serum irisin with hemodialysis doses and a negative correlation of serum irisin with BMI requires further investigations in other patients with more patients.

Effect of probiotics on the intestinal microbiota of hemodialysis patients: a randomized trial.

Intestinal dysbiosis contributes to the progression of renal failure and cardiovascular diseases in patients with chronic kidney disease. Probiotics is a promising intervention to improving intestinal dysbiosis. A double-blind clinical trial to investigate the ability of probiotics to modulate gut microbiota compositions in patients receiving hemodialysis (HD) was undertaken. Fifty HD patients were enrolled and randomized, receiving either probiotics or placebo for 6months. The responses to the interventions on gut microbiome, serum and fecal metabolome, serum albumin and endotoxin, endothelial activation markers and inflammatory markers were assessed. Totally, 22 in the probiotics group (11 males; 14 non-diabetic) and 23 in the placebo group (13 males; 17 non-diabetic) completed the study. Compared to that in the placebo group, probiotics did not significantly alter species diversity of the fecal microbiome. Probiotics did, however, restore the community composition, with particular significance in non-diabetic HD patients (P = 0.007 by Adonis analysis). Specifically, according to the results of linear discriminate analysis effect size, probiotics raised the proportions of family Bacteroidaceae and Enterococcaceae, and reduced Ruminococcaceae, Halomonadaceae, Peptostreptococcaceae, Clostridiales Family XIII. Incertae Sedis and Erysipelotrichaceae in non-diabetic HD patients. Additionally, probiotics reduced the abundances of several uremic retention solutes in serum or feces, including indole-3-acetic acid-O-glucuronide, 3-guanidinopropionic acid, and 1-methylinosine (P < 0.05). In the probiotic arm, no significant changes were observed in other secondary outcomes. Taken together, outcomes from this study suggest that probiotics do have benefits on improving intestinal imbalances and lowering exposure to several uremic toxins in HD patients.