Chronic Renal Failure Patients Research Articles

Efficacy and Safety of Different Modalities for Treatment of Erectile Dysfunction in Chronic Renal Failure Patients

Background Erectile dysfunction has been found to be significantly more common in men with chronic kidney disease (CKD) than in the general population. Objective of the Study Detection of the safest and most effective medical treatment of erectile dysfunction(ED) in chronic renal failure patients. Patients and Methods . This study was conducted at Ain Shams University Hospitals with a sample size of 60 patients: 15 patients per group. We assessed the improvement in the erectile function through assessment of IIEF (International Index of Erectile Function) score and EHS (Erection Hardness Scale) score pre- and post-administration of the drugs used in the study (oral sildenafil, oral vardenafil, oral tadalafil and intracavernosal injection of alprostadil). Results There is a statistically significant increase in IIEF score post-administration of the drugs used in this study with p value of < 0.001 and a mean difference of 6.92. The mean score of IIEF pre-administration of the drugs used was 8.13 and post-administration was 15.05. There is also a statistically significant difference in EHS score with p value of < 0.001 and mean difference of 1.4. The mean score of EHS pre-administration of the drugs was 1.22 and post-administration was 2.62. From the four drugs used in this study, Alprostadil showed the highest improvement in IIEF and EHS scores. The study also showed a negative correlation between age, duration of haemodialysis and serum creatinine with erectile function. In addition, there was a statistically significant decrease in pre- and- post-treatment IIEF and EHS scores in diabetic cases than in the non-diabetic cases. Conclusion There is high incidence of ED in CKD patients. The drugs used in the study showed improvement in the erectile function with mild side effects. Alprostadil had the best IIEF and EHS scores amongst the four drugs.

Anatomical and Functional Evaluation of RNFL Parameters and Choroidal Thickness Changes in Patients with Chronic Renal Failure Undergoing Hemodialysis Using Spectral-Domain Optical Coherence Tomography and Visual Field

Background There is a structural analogy between the glomerular vascular network and the choroidal circulation. With hemodialysis (HD), lots of alterations occur in patients' homeostasis and metabolic parameters. These alterations affect the eye and may cause neuro-ophthalmologic complications. Aim To evaluate anatomical and functional changes of retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL), and changes in subfoveal choroidal thickness (SFCT) in patients with chronic renal failure (CRF) on HD. Methods This case control study was carried on 20 eyes of 20 CRF patients (HD group) and 20 eyes of 20 healthy individuals. 10 of the HD group were non-diabetic (NDM subgroup) and 10 were diabetic (DM subgroup). For all eyes, the thickness of peripapillary RNFL, GCL, and SFCT were measured by optical coherence tomography (OCT) (RS-3000; NIDEK, Japan) and visual field (VF) analysis using Humphrey field analyzer (Carl Zeiss, USA). Results A statistically significant decrease in peripapillary RNFL thickness in HD group when compared to the control group in most analyses, but did not amount to statistical significance in the temporal quadrant and in 5 of the studied clock hour sectors. There was also a statistically significant decrease in the macular GCL thickness of HD group when compared to the control group in both hemifields, and in all of the 8 subfields. The results of the SFCT reported in HD group were also significantly less than that reported in the control group. Analysis of results from VF demonstrated a highly significant depression in both MD and PSD of the HD group when compared to the control group. The difference between the NDM and DM subgroups was not significant in any of the studied parameters. Conclusion Our results demonstrate highly significant retinal and choroidal changes in CRF patients on HD. Thus, we recommend that CRF patients undergo regular ocular examination by OCT to prevent early ocular damage.

Effect of Direct Acting Anti-Viral Drugs on Myostatin Level among CRF Egyptian Patients with Chronic HCV Infection and Its Correlation with Sarcopenia

Background Chronic kidney disease (CKD) is a progressive condition that might negatively affect musculoskeletal health. Secondary sarcopenia due to chronic kidney disease may be accompanied with elevated fall risk and mobility limitations. The loss of muscle mass, in addition to the impact of poor body composition on muscle strength and mobility status are necessary for classification and staging of sarcopenia. Aim of the Work The main aim of this study was to assess the effect of direct anti-viral drugs on myostatin level and its correlation with sarcopenia in CRF patient with chronic HCV. Patients and Methods This was a case control study was conducted at gastroenterology outpatients’ clinics and internal medicine and nephrology department Ain Shams university hospital and om elmasryeen general hospital including 50 chronic renal failure patients with chronic HCV infection and normal persons; they were divided into: Group A: 20 chronic HCV patient received direct acting anti-viral drugs. Group B: 20 chronic HCV patients didn’t receive direct acting antiviral drugs. Group C: 10 normal persons without chronic renal failure or hepatitis C virus. The duration of the study ranged from 6-12 months. Results There was no statistically significant difference between the studied groups as regard demographic data, there was high statistically significant difference between the studied groups as regard weight, lean body mass and BMI, there was high statistically significant difference between the studied groups as regard Hb, there was high statistically significant difference between the studied groups as regard history of ALT and AST and significant difference between the two studied groups as regards Alpha fetoprotein, there was high statistically significant difference between the studied groups as regard history of BUN and significant difference between the two studied groups as regards Creatinine, there was statistically significant difference between the studied groups as regard Serum myostatin. Conclusion The serum myostatin level was significantly lower in chronic HCV patients didn’t receive direct acting anti-viral drugs than those who received direct acting anti-viral drugs and control groups.

Paraoxonase 1 Activity and Renal Replacement Therapy for Chronic Renal Failure: A Meta-Analysis.

Chronic renal failure (CRF) is associated with the development of cardiovascular disease (CVD). Paraoxonase 1 (PON1), an antioxidant enzyme, shows cardioprotective properties and has been proposed as a therapeutic marker for CRF. A systematic analysis of the literature assessing the association between PON1 activity and renal replacement therapy (RRT) of CRF is currently lacking. Therefore, we set out to perform a meta-analysis of the available data on PON1 in RRT of CRF. We searched three electronic databases for studies on PON1 activity in CRF patients with RRT such as hemodialysis (HD), peritoneal dialysis (PD), or renal transplantation (RTx), published before June 2023. A random-effects and network meta-analysis were performed. A total of 53 studies were eligibly identified. Compared to CRF patients without RRT, RTx patients had higher paraoxonase activity (standard mean difference (SMD), 1.76, 95% confidence interval (CI), 0.76-2.75), followed by HD (SMD, 0.73; 95% CI, 0.02-1.45) and PD patients. Likewise, RTx patients had higher arylesterase activity (SMD, 1.84, 95% CI, 0.18-3.50), followed by HD and PD patients. Also, paraoxonase activity was increased after HD (SMD, 0.59, 95% CI, 0.16-1.03). In conclusion, the overall data demonstrated that PON1 activity is higher in CRF patients with RRT, particularly RTx, followed by that of HD and PD. Measuring PON1 activity can also be included to the paraclinical toolbox for the management of RRT, in addition to the understanding of CRF-related pathophysiology. Regarding the selection of RRT types and their potential to prevent CVD, more research is required.

A Descriptive Study to Assess the Quality of Life in Chronic Renal Failure Patients Undergoing Haemodialysis in Selected Hospital, Udaipur

A Descriptive Study to Assess the Quality of Life in Chronic Renal Failure Patients Undergoing Haemodialysis in Selected Hospital, Udaipur

The Relationship between Quick Of Blood and Fatigue in Stage V Chronic Renal Failure Patients Undergoing Hemodialysis

Chronic kidney failure is one of the non-communicable diseases, where the disease process takes a long time so that kidney function cannot return to its original state. Quick of blood should be <200 mL/minute in Indonesian people because if the QB rotation is too fast it can cause nausea, dizziness and rupture of the vein Regarding its relationship with the incidence of fatigue level itself, there has not been much research. However, giving very high Quick of Blood will have an impact on intra and post hemodialysis complications. The purpose of this study was to determine the relationship between quick blood and fatigue in stage V chronic kidney failure patients after undergoing hemodialysis. The design of this study used quantitative research with descriptive analytic, namely cross sectional. The number of samples in this study were 62 respondents with a purposive sampling data collection technique. Measuring tool used FACIT Scale. The Spearman Rank statistical test on the correlation and regression test of the quick of blood relationship with fatigue shows a weak relationship (r = 0.001) and has a negative pattern, the lower the quick of blood, the more fatigue increases. Statistical test results obtained (p = 0.992) (Ho accepted and Ha rejected). In this study there was no significant relationship between quick of blood and fatigue. The results of this study are expected to increase insight and knowledge in the field of patient care to reduce fatigue in hemodialysis action.

Design of Beta-2 Microglobulin Adsorbent Protein Nanoparticles.

Beta-2 microglobulin (B2M) is an immune system protein that is found on the surface of all nucleated human cells. B2M is naturally shed from cell surfaces into the plasma, followed by renal excretion. In patients with impaired renal function, B2M will accumulate in organs and tissues leading to significantly reduced life expectancy and quality of life. While current hemodialysis methods have been successful in managing electrolyte as well as small and large molecule disturbances arising in chronic renal failure, they have shown only modest success in managing plasma levels of B2M and similar sized proteins, while sparing important proteins such as albumin. We describe a systematic protein design effort aimed at adding the ability to selectively remove specific, undesired waste proteins such as B2M from the plasma of chronic renal failure patients. A novel nanoparticle built using a tetrahedral protein assembly as a scaffold that presents 12 copies of a B2M-binding nanobody is described. The designed nanoparticle binds specifically to B2M through protein-protein interactions with nanomolar binding affinity (~4.2 nM). Notably, binding to the nanoparticle increases the effective size of B2M by over 50-fold, offering a potential selective avenue for separation based on size. We present data to support the potential utility of such a nanoparticle for removing B2M from plasma by either size-based filtration or by polyvalent binding to a stationary matrix under blood flow conditions. Such applications could address current shortcomings in the management of problematic mid-sized proteins in chronic renal failure patients.

Effectiveness of a breathing exercise on respiratory function in patient undergoing hemodialysis among chronic renal failure patient

Effectiveness of a breathing exercise on respiratory function in patient undergoing hemodialysis among chronic renal failure patient

A Cross-Sectional Study of Dermatologic Manifestations in Patients with Chronic Renal Failure on Hemodialysis

Background: Chronic renal failure patients undergoing dialysis suffer from various side effects and complications where skin ailments are one of them. Skin is the largest and one of the most dynamic organs of the body and can be used as a window since it is easily accessible for observation and reflects changes seen in multiple organs including kidneys. Objective: The objective of this study is to describe various cutaneous manifestations in chronic kidney disease patients undergoing hemodialysis. Materials and Methods: A hospital-based, cross-sectional, observational study was conducted in the department of dermatology, venereology, and leprosy at a tertiary care center from November 2019 to May 2021. The demographic details and clinical manifestations were recorded. Data were recorded as numbers and percentages. For categorical data, the number and percentage were used in the data summaries, and data were analyzed by the Mann‒Whitney U test for the comparison of two data. Results: A total of 94 patients were included in the study. The most common manifestation observed was pruritus (85.1%), followed by xerosis (84%). Other findings seen in the study were mainly nonspecific changes such as pallor (59.57%), diffuse hyperpigmentation (3.2%), and ecchymosis (16%). Nail changes (56.38%) observed were half-and-half nails (22.6%), onycholysis (11%), and Beau’s lines (9%). Mucosal changes (36.17%) included depapillated tongue (12.8%) and macroglossia (8.5%). Other findings such as skin infections and keloid were also noted. New finding such as angina bullosa hemorrhagica was seen in one patient. Specific change like Kyrle’s disease was seen in 6.4% of the study group and 50% of these patients had concomitant diabetes mellitus. Conclusion: Patients on hemodialysis present with an array of cutaneous manifestations. The most common include pruritus and xerosis. Prompt diagnosis and early treatment help alleviate many of the cutaneous manifestations posed due to hemodialysis.

Correlation with renin-angiotensin-aldosterone and glomerular filtration rate in chronic renal failure patients

Background: One of the more significant hormonal systems, the renin-angiotensin-aldosterone system, controls the kidney function, adrenal gland through its effect on the balance of sodium and potassium, blood pressure, fluid volume, and also manages the functions of cardiovascular.
 Objective: To clarify the interrelationship between renal dysfunction and renin-angiotensin-aldosterone system.
 Patients and Methods: One hundred samples were collected from December 1, 2022, to February 18, 2023, from Al Shams Medical Laboratories (56 male, and 44) female, age range (of 45-60 years), all of them were volunteers suffering from chronic renal failure in the third stage the average glomerular filtration rate was 35. 70 ± 0.37 125 mL/min/1.73m2. and under conservative treatment. Kidney function test, active renin, angiotensin II, and aldosterone were assessed in the serum of all subjects. The p - value of differences less than 0.05 is measured significant, and uses the statistical package for the social sciences (23) software to calculate the correlation coefficient between various parameters.
 Results: The result shows relationship between the changes in GFR with creatinine, urea and active renin, the mean GFR showed significant negative correlated with mean creatinine (R = -0.76, p < 0.01. As well as the mean GFR with mean urea (R = -0.64, p < 0.01). The mean GFR also showed significant negative correlated with mean active renin in (R = -0.41, p < 0.01). Also, the mean serum active renin level was significantly positive correlated with mean aldosterone (R =0.33, p < 0.05).
 Conclusion: Renin enzyme is inversely related to renal dysfunction, so when the glomerular filtration rate decrease, the higher the renin increased, and as a result, the increase in blood pressure in chronic renal failure patients.

Lipid Profile in Chronic Renal Failure Patients on Haemodialysis

Objective: This study aims to evaluate the levels of lipid profile parameters in Chronic Renal Failure patients on Maintenance hemodialysis and to compare its level with age matched healthy control population. Method: Cross sectional study involving 262 Individuals between the age 46 -75 years in the population of Bengaluru, India between February 2022 to May 2023. Venous blood was collected from 131 CRF patients on MHD and from 131 healthy individuals and analyzed for lipid profile parameters TC, TG, VLDL,LDL,HDL.and urea,creatinine. Results: In MHD patients, serum TG and VLDL levels were found to be significantly elevated compared to healthy control population. HDL was significantly reduced compared to control healthy population. There was no significant change in the levels of TC and LDL. Conclusion: Frequent monitoring of these lipid profile parameters may help in better treatment, hence itmay reduce the morbidity and mortality of Patients on MHD.

Relationship between lenght of undergoing hemodialysis therapy with insomnia in chronic renal failure patients

Complications that are often experienced by patients with chronic kidney failure undergoing hemodialysis are sleep disturbances. Sleep disturbances are experienced by at least 50-80% of patients undergoing hemodialysis > 12 months. The purpose of this study was to determine the relationship between duration of hemodialysis therapy and insomnia in patients with chronic kidney failure at Arifin Achmad Hospital, Riau Province. The research method is a cross sectional approach. The population of this study were all 58 patients undergoing hemodialysis at Arifin Achmad Hospital. The sampling method was purposive sampling. The measuring instrument used in this research is the Insomia Severity Index (ISI) questionnaire. Statistical test using Chi Square test. Results Most of the levels of mild insomnia were 26 respondents (44.8%), moderate insomnia was 21 respondents (36.2%), not clinically significant as many as 8 respondents (13.8%), and severe insomnia was 3 respondents (5.2%). The results of statistical tests obtained p value of 0.487 > (0.05). It can be concluded that there is no relationship between undergoing hemodialysis therapy with insomnia in patients with chronic kidney failure at Arifin Achmad Hospital, Riau Province. Suggestions for further research that can be expected to examine the factors associated with insomnia in patients with chronic kidney failure.

Self-care and Quality of Life in Patients with Chronic Renal Failure Undergoing Hemodialysis at Sulaimaniyah Province, Kurdistan Region of Iraq

Background: Chronic renal failure (CRF) is a significant and growing public health issue globally with a negative impact on self-care and quality of life (QoL). Self-care and QoL are essential aspects of controlling the adverse effects of the illness.
 
 Objectives: To assess self-care and QoL of patients with CRF who undergo hemodialysis (HD).
 
 Patients and Methods: A descriptive-analytical design was carried out in Sulaimani Province Hemodialysis Centers/Unit from March to September 2022. About 150 patients with CRF undergoing hemodialysis consented to participate in the study. Non-probability convince sample technique was used to select the participants. The data were collected through a questionnaire by direct interview.
 
 Results: Most patients were ≥60 years, males, married, illiterate, lived in an urban area and had barely sufficient economic status with 4-6 family members. The study's findings revealed inadequate self-care in >50% of patients. A significant correlation between self-care and QoL in limitation of activities was found for CRF patients who underwent Hemodialysis with no correlation for general health, physical and emotional, and energy and emotion. Also, there was a significant difference between QoL and age (for the general health domain), gender, and level of education (for the limitations of the activities domain). Mean self-care measurement was significantly associated between previous occupation and duration of Hemodialysis.
 
 Conclusions: Most patients had inadequate self-care and poor QoL, which means that higher self-care performance was associated with better QoL in the limitation of activities only and no other QoL domains.

ANEMIA IN HYPERTENSIVE PATIENTS WITH CHRONIC RENAL FAILURE, WHAT ARE THE CHARACTERISTICS?

Objective: During chronic renal failure, the progressive impairment of kidney functions results in a set of manifestations, initially biological, then clinical. Anemia and high blood pressure are common complications during chronic kidney disease. The aim of this study is to determinate the main characteristics of anemia in hypertensive patients with chronic kidney disease Design and method: This descriptive work is a retrospective cross-sectional study aimed at evaluating the iron status of 70 hypertensive chronic renal failure patients. The average age in this study was 65 years with a male predominance (51%). In our study, 70 patients with chronic renal failure of all stages participated, hypertensive and anemic. The count of the blood elements and the hemoglobin assay were done by optical measurement using the ADVIA® 2120i automaton. The assay of vit B12, folate and ferritin in the blood by enzymatic chemiluminescence. Results: In our study, the mean hemoglobin was 10.18 g/dl, In our series of hemodialysis patients, mean serum ferritin was 276±207.14 ng/ml. In our population, blood pressure averages are of the order of: 130.29 ± 22.33 mm Hg for PAS, and 69.86 ±10.16 mm Hg for DBP. Regarding patients with chronic renal failure not on dialysis 43.5% of patients had serum ferritin low. 50% had normal ferritinemia, and 6.45% of patients had elevated serum ferritin. Ford's study found 2.92% of patients with low serum ferritin, 25.05% had a normal level, and 72.02% had hyperferritinemia. At 26% of patients in our population, the blood pressure figures were > 140/90 mmHg, while 74% of patients reached the target . Conclusions: Chronic renal failure exposes to numerous hematological and cardiovascular type complications, which can themselves induce health problems, in addition Correction of anemia is not always beneficial for patients suffering from CKD in due to increased blood pressure. Perform periodic biological and hormonal analyzes. Recommend lifestyle and dietary measures in all hypertensive patients, chronic renal failure. Carry out awareness campaigns with the general public for a better understanding of chronic kidney disease

Peran Pelatihan Shalat Khusyuk dalam Menurunkan Kecemasan Pasien Gagal Ginjal Kronik yang Menjalani Hemodialisis

The purpose of this study was to observe the effect of solemn pray training against the level of anxiety of chronic renal failure patients that are undergoing hemodialysis. The number of participants was eight chronic renal failure patients that are undergoing hemodialysis for less than 1 year to 1,5 years. The participants were divided into two groups, which were experiment and control groups in which each group consist of four members. This study was conducted using the experimental design with the measurements prior to and after the training, and also the follow-up that was done two weeks after the training. The training has lasted three sessions (380 minutes). The level of anxiety was measured using the scale of DASS (Depression, Anxiety, and Stress Scale). The training module referred to the theory of “Menggapai Shalat Khusyuk” by Al-Ghazali. Results of the study indicated that there was a significant effect of solemn pray training against the level of anxiety after the training. This study showed that the training can be used as of the therapies for decreasing the anxiety level of chronic renal failure patients undergoing hemodialysis.

Effect of Hemodialysis on Nutritional Status in Chronic Renal Failure Patients

Chronic kidney failure is a condition where there is a decrease in kidney function in maintaining balance in the body, and the process takes place gradually until there is a decrease in function and the kidney cannot return to its original function. Hemodialysis functions to excrete waste products and toxic substances such as urea and creatinine in the body, but hemodialysis carries the risk of causing malnutrition because nutrients such as protein and glucose, as well as water-soluble vitamins, are also filtered during the hemodialysis process. This study aims to determine the relationship between duration of hemodialysis and nutritional status in chronic kidney patients at the Hemodialysis Unit at Tangerang District General Hospital. The design used in this study was an analytic survey with a cross-sectional approach. Sampling used a purposive sampling technique with a total of 58 respondents. The analysis in this study used the chi-square test. The results of the chi-square test obtained a p-value of 0.038 (α=0.05), which means that there is a relationship between the duration of hemodialysis and nutritional status in chronic kidney patients at the Hemodialysis Unit at the Tangerang Regency General Hospital. It is hoped that health service institutions will improve services by documenting BMI to help monitor the nutritional status of patients while undergoing hemodialysis.

Comparison of Quality of Life and Comfort Levels in Patients with Three Different Chronic Diseases

Aim: This research was conducted to compare the quality of life and general
 comfort levels of patients with three different chronic diseases.
 Method: The study was conducted with cross-sectional design. The research
 sample consists of adult patients who were treated in the chest diseases service,
 hemodialysis unit, cardiology service, coronary intensive care unit of two hospitals.
 The study consisted of 466 patients. In the study, data were collected from the
 patients with the survey, Quality of Life General (WHOQOL-BREF) and General
 Comfort Scale.
 Results: In the study, when looking at the effect of the WHOQOL-BREF on
 General Comfort level in 3 chronic disease groups, it is seen that the biggest effect
 is 21.4% Chronic Obstructive Pulmonary disease (COPD)patients, this is followed
 by Chronic Renal Failure (CRF) patients with 18.2%, Heart Failure (HF) patients
 with 14.6%.
 Conclusions and Suggestions: In the study, it was found that socio-demographic
 characteristics and quality of life affect the level of General Comfort in HF
 patients, COPD and CRF patients.

Evaluation of Adjusted Calcium Levels in Patients of Chronic Renal Failure with Hypo-Albuminemia

Objective: To compare adjusted calcium levels with ionised Calcium in chronic renal failure patients with hypoalbuminemia for the correct assessment of their Calcium status.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi Pakistan, from Mar 2020 to Jan 2021.
 Methodology: A total of 304 individuals aged 18 to 90 years, of either gender were included in the study. Participants were differentiated into stages of Chronic renal failure based on the estimated glomerular filtration rate calculated through the Chronic Kidney Disease Epidemiology Collaboration equation. Serum total Calcium, urea and creatinine were analysed on ADVIA 1800R Clinical Chemistry Auto analyser. In addition, ionised Calcium was analysed on Cobas b221 blood gas and electrolyte analyser.
 Results: Mean age of the study participants was 56.3±16.03 years. 130(42.5%) individuals had stage-5 while 102(33.3%) had stage 4 chronic kidney disease. Based on ionised Calcium concentration, 37.3% of participants had hypocalcaemia, 57.2% had normocalcaemia, and 4.9% had hypercalcaemia. 57.5% had albumin concentration between 20-29g/L. Cohen’s Kappa statistical analysis showed adjusted Calcium to be a poor predictor of the correct Calcium status of the patients with hypoalbuminemia.
 Conclusion: Adjusted Calcium, using the Modified Payne formula, overestimates Calcium status in patients of chronic renal failure with hypoalbuminemia when compared with total unadjusted Calcium levels hence misclassifying true hypocalcaemic patients as normocalcaemic.Keywords: Adjusted calcium, Chronic renal failure, Estimated glomerular filtration rate, Hypoalbuminemia, Ionised calcium.

Variations in Serum Iron Profile, in Pre and Post Hemodialysis Patients of Chronic Renal Failure

Objective: To determine the variations in iron profile in pre- and post-hemodialysis patients with chronic renal failure. Material and methods: This cross-sectional study was conducted at the physiology department with the collaboration of the urology department of Liaquat University Hospital Hyderabad, from April 2021 to September 2021. Patient of either gender with chronic kidney disease between the ages of 18- and 50-years undergoing hemodialysis were included. Blood samples were collected using serum tubes to analyze the iron profile before and after dialysis. Changes in hematological parameters were evaluated by comparing pre and post data. All data were recorded in a proforma and entered into the SPSS 26.0 version for the purpose of analysis. Results: A total of 167 patients were studied; their mean age was 43.23+12.90 years. Out of all study subjects 61.1% were males and 38.9% were females. The mean duration of dialysis was 13.40 ± 2.88 months. As per the pre- and post-serum iron profiles, the average serum iron level, serum ferritin level, and serum TIBC were statistically insignificant (p- >0.05). Conclusion: In conclusion, the iron levels before dialysis were observed to be higher than after dialysis, and the average levels of serum ferritin and total iron binding capacity (TIBC) were found to be higher after dialysis, albeit statistically insignificant. Keywords: Hemodialysis, serum iron, ferritin, TIBC

Unraveling the Secrets Behind the Multidrug-Resistant Tuberculosis Treatment Outcome in Chronic Renal Failure Patients Requiring Hemodialysis: A Systematic Review.

Multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR TB) is a global concern, with 450,000 new cases and 191,000 deaths in 2021. TB and chronic kidney disease (CKD) have been associated since 1974, with suggested explanations such as oxidative stress, malnutrition, dysfunction in vitamin D metabolism, and a compromised cell-mediated immune response. End-stage renal failure patients are more likely to acquire drug resistance due to poor adherence, adverse drug reactions, and inappropriate dose adjustment. We then aim to evaluate the therapeutic outcome of multidrug-resistant TB of the lungs in patients who require hemodialysis in terms of successful treatment (cured and treatment completed) and the associated factors for a favorable outcome. Our secondary goal is to identify unfavorable treatment outcomes (treatment failed, patient died, or patient lost to follow-up) and the underlying associated factors. We conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 Guidelines for this systematic review. We included adults (>19 years old) with chronic kidney disease who needed hemodialysis and had microbiologically confirmed multidrug-resistant pulmonary TB, excluding patients who had a renal allograft transplant, were on peritoneal dialysis, hadextrapulmonary TB, were childrenand pregnant patients. We searched PubMed, MEDLINE, PubMed Central, ScienceDirect, Public Library of Science (PLOS), and Google Scholar. Keywords were combined with the Boolean "AND" operator to gather results as well as the medical subject heading (MeSH) search strategy. After screening study articles by reading their titles and abstracts, the following tools were used to assess the risk of bias: the Newcastle-Ottawa scale for observational studies, the Assessment of Multiple Systematic Reviews (AMSTAR) checklist for systematic reviews, and the Joanna Briggs Institute (JBI) assessment tool for case reports.Primary and secondary outcomes were assessed, and a conclusion was made. We gathered 21,570 studies from the databases between 2013 and 2023, with 30,062 total participants. There were eight eligible studies for review. Patients with CKD, particularly those on dialysis, are at increased risk of TB due to a combination of factors that contribute to immunosuppression. TB reactivation is common in chronic renal failure patients. Diagnostic samples such as sputum and pleural fluid had lower sensitivity rates compared to tissue samples, which led to delays in diagnosis and treatment and, most importantly, contributed to drug resistance. All new dialysis patients should undergo interferon-gamma release assay testing. TB-infected patients with severe renal disease (eGFR 30 ml/min) had increased morbidity and mortality; however, the use of directly observed treatment, short-course (DOTS), and renal-dose adjustment of anti-TB medications significantly reduced these risks. Drug-induced hepatitis and cutaneous reactions were common adverse effects of anti-TB medications. A therapeutic drug monitoring guideline is required to reduce these adverse events and even mortality. Additional research is required to assess the safety and efficacy of therapeutic regimens, as well as their outcomes, in this population with multidrug-resistant TB.