Predialysis Group Research Articles

Metabolic acidosis and sexual dysfunction in chronic kidney disease in predialysis group: Cross-sectional study from a single center.

This study aimed to investigate the prevalence of sexual disorders in stage 2 - 5 chronic kidney disease (CKD) during predialysis and its relationship with laboratory parameters. This cross-sectional study included 110 predialysis patients and 110 healthy controls admitted to clinics. The International Index of Erectile Function (IIEF) and Female Sexual Function Index (FSFI) were used. Sexual dysfunction was detected in 76% of female patients and 31.4% of the control group, and the FSFI total and subscale scores of the patients were significantly lower than those of the control group. The frequency of erectile dysfunction in male patients and controls was 56.7% and 33.3%, respectively. The erectile function, sexual satisfaction, and overall satisfaction scores on the IIEF scale were significantly lower than those in the control group. Low glomerular filtration rate, high calcium levels, increased C-reactive protein, anemia, and metabolic acidosis in male and female patients, and testosterone deficiency in male patients were associated with sexual dysfunction. In multiple regression analysis, eGFR was the only independent variable associated with sexual dysfunction. Luteinizing hormone (LH) and prolactin levels increased as the disease progressed in men and women with sexual dysfunction, while testosterone levels decreased in male patients. Low testosterone levels were related to erectile dysfunction. The increase in parathormone and prolactin levels was related to loss of libido in the male and female patient groups. Metabolic acidosis and low eGFR appear to be the most important risk factors contributing to sexual disorders in patients with CKD.

#2085 Testosterone and markers of nutritional status correlate with leptin in chronic kidney disease

Abstract Background and Aims Leptin, the anorexic hormone, also appears to have a proatherogenic effect, contributing to the development of cardiovascular morbidity and mortality. Current data on factors related to serum leptin levels in different stages of chronic kidney disease (CKD) are inconsistent. The aim of this study was to evaluate the determinants of leptin level in pre-dialysis stage of CKD. Method We performed a cross-sectional study, including 73 patients, mean age 67 (60-78) years, 38% diabetic, with GFR 31 ± 20.85 ml/min per 1.73 m(2). We followed the correlations of leptin with inflammatory, nutritional, lipid markers, testosterone and others by univariate analysis and subsequently determined the strongest predictor for leptin level by multivariate analysis. Results Table. Correlation between the parameters and leptin in CKD pre-dialysis group. In the CKD pre-dialysis patients the best predictors for leptin level were body mass index, adipose tissue mass, lean tissue mass (for each p < 0.001) and testosterone (p < 0.001). Blood glucose (p = 0.013) was also a significant determinant of leptin level in pre-dialysis CKD patients. Conclusion In pre-dialysis CKD patients, testosterone levels together with nutritional markers are the best predictive markers for leptin levels. The management of these determinants can influence the level of leptin in CKD pre-dialysis patients and future research will determine if it can influence the atherosclerotic process.

Evaluation of hepatosteatosis and gallstone disease in patients with chronic kidney disease.

The prevalence rates of hepatosteatosis and gallstones are increasing owing to the multifactorial causes of chronic kidney disease, and the prevalence may change with the availability of different forms of renal replacement therapy. We aimed to determine the incidence or prevalence rates of hepatosteatosis, cholelithiasis, and acute cholecystitis in patients with chronic kidney disease and compare them between renal replacement therapy modalities. A total of 270 patients (90 with chronic kidney disease stages III-V, 90 undergoing peritoneal dialysis, and 90 undergoing hemodialysis) were included and categorized into the pre-dialysis, hemodialysis, and peritoneal dialysis groups. The patients were questioned about previous gallbladder surgeries and chronic diseases. The results of abdominal ultrasonography, tomography, and magnetic resonance imaging were retrospectively evaluated with respect to the findings on the hepatobiliary system. Hepatosteatosis and cholelithiasis were diagnosed by expert radiologists on the basis of abdominal ultrasonography, tomography, and magnetic resonance imaging findings. The prevalence rates of hepatosteatosis, cholelithiasis, and other liver findings were compared between the groups. Hepatosteatosis and cholelithiasis were detected in 16.7% and 21.5% of the 270 cases, respectively. Hepatosteatosis was present in 17.8%, 25.6%, and 6.7% of patients in the pre-dialysis, hemodialysis, and peritoneal dialysis groups, respectively. The prevalence of hepatosteatosis was significantly higher in patients undergoing hemodialysis than in patients undergoing peritoneal dialysis (p = 0.002). However, no statistically significant difference was found between the peritoneal dialysis and pre-dialysis groups or between the hemodialysis and pre-dialysis groups (p >0.05). The prevalence rates of cholelithiasis were 15.6%, 28.9%, and 20.0%, in the pre-dialysis, hemodialysis, and peritoneal dialysis groups, respectively, and there were no statistically significant differences among the groups. The incidence of acute cholecystitis was significantly higher in the hemodialysis group than in the pre-dialysis group (p = 0.006). Our study showed that the hepatobiliary system is frequently affected in chronic kidney disease and that the findings may differ depending on the renal replacement therapy modality.

Differential Status of Serum Arginine, Arginase and Nitric Oxide in Patients of Chronic and Advanced Stage Kidney Disease Undergoing Hemodialysis

Background: Chronic kidney disease (CKD) is characterized by deterioration of endothelial function which is associated with reduced availability of nitric oxide. The objective of the study was to assess the differential status of the serum levels of arginine, arginase, NO, urea and creatinine in CKD patients not on hemodialysis and in end stage renal disease (ESRD) patients receiving hemodialysis. Material and Methods: In this case control study, clinically diagnosed 30 CKD patients (group I), 30 ESRD patients before hemodialysis (Group II), 30 patients with ESRD after first hemodialysis (group III) and 30 patients with ESRD after second hemodialysis (Group IV) were included. 30 healthy volunteers were included for comparison. Serum arginine, arginase, nitric oxide, urea and creatinine were estimated by colorimetric and spectrophotometric methods. Results: Serum creatinine and urea levels were evaluated to determine the severity of renal dysfunction. A significantly decreased serum arginine and nitric oxide levels whereas significantly increased serum arginase levels were observed in ESRD patients when compared to levels in CKD patients. Serum creatinine levels were significantly decreased after second hemodialysis. But there was no significant change in the serum levels of arginine, arginase and nitric oxide in ESRD patients after first and second hemodialysis compared to pre-dialysis group. Conclusion: The findings of the study throw light upon the differential status of serum arginine, arginase and nitric oxide in CKD and in ESRD patients. The evaluation of decreased nitric oxide levels coupled with elevated arginase activity may help in assessing progression of CKD to ESRD along with traditional markers of kidney function. Additionally, evaluation of serum arginase activity may provide useful prognostic information, with large study group and further follow-up, in hemodialysis patients.

Pre-Emptive Kidney Retransplantation from Deceased Donors

There is uncertainty about the best approach to replacement treatment for kidney transplant recipients with chronic terminal graft dysfunction, since a retransplant could be performed before the resumption of dialysis, thus avoiding this treatment and the dilemma of whether or not to suspend immunosuppressive therapy. However, there is limited experience in pre-emptive repeat transplantations, and none from deceased donors. This study aims to assess the results of a pre-emptive retransplantation program with brain-dead deceased donors. We designed a retrospective matched cohort study, including 36 recipients in the pre-dialysis group and 36 controls who were already on dialysis, matched for donor age and transplant date, which could not differ by more than 7 days between pairs. The variables used to standardize the cohorts were donor and recipient age and sex, blood group, duration of the first graft, time on the waitlist to receive the second graft, cold ischemia time, induction and maintenance of immunosuppression, and HLA antibodies (-) prior to retransplantation. The efficacy variables were early graft loss, acute rejection, delay in graft function, renal function at the end of follow-up, survival time, and recipient and graft survival at 24 and 48 months’ follow-up. The pre-dialysis group presented a significantly shorter waitlist time, lower immunization status, and a significantly longer duration of the first graft than the control group. The percentage of recipients who presented early graft loss, delayed renal function, or acute rejection was similar between groups. No significant differences were observed in kidney function or in the survival of the recipient or graft. Retransplantation yields good outcomes in patients with terminal chronic dysfunction, helping to avoid recurrence to dialysis, shortening the time spent on the waitlist, reducing the risk of producing antibodies, and resolving the dilemma of whether or not to stop immunosuppression.

Association of Apical Periodontitis with Different Stages of Chronic Kidney Disease Measured by Glomerular Filtration Rate and Systemic Markers: An Observational Study

IntroductionThe aim of this study was to assess the prevalence and severity of apical periodontitis (AP) in subjects with different stages of chronic kidney disease (CKD) and its association with systemic markers. MethodsIn this cross-sectional study, 105 patients with CKD (n = 35 each in the early, predialysis, and hemodialysis groups) and 105 healthy controls were included. The prevalence, number of teeth with AP (endodontic burden [EB]), and the severity of AP were recorded. High- sensitivity C-reactive protein, blood urea, and serum creatinine levels were also recorded. Logistic regression was applied to determine the possible association between CKD and AP in the study population, and linear regression was performed to predict the effect of AP on systemic markers in CKD patients. ResultsAP in at least 1 tooth was found in 75.2% of CKD patients and 40.9% of the controls (P < .05). CKD patients were 4 times more likely to have AP than controls (P < .05; odds ratio = 3.954; 95% confidence interval, 2.09–7.45). EB and the severity of AP were also significantly higher in CKD patients than the healthy controls (P < .05). Although higher values of EB and severe AP were observed with the progression of disease, the difference was not significant. The severity of AP was significantly associated with an increase in serum creatinine, blood urea, and a decrease in estimated glomerular filtration rate (P < .05) in CKD patients. ConclusionsAP was significantly more prevalent in the CKD group. The association between the severity of AP and CKD markers suggests that AP could possibly alter the progression of CKD. However, these findings do not establish a cause-and-effect relationship.

Investigation of XPD, miR-145 and miR-770 expression in patients with end-stage renal disease.

The effective maintenance of genome integrity and fidelity is vital for the normal function of our tissues and organs, and the prevention of diseases. DNA repair pathways maintain genome stability, and the adequacy of genes acting in these pathways is essential for disease suppression and direct treatment responses. Chronic kidney disease is characterized by high levels of genomic damage. In this study, we examined the expression levels of the xeroderma pigmentosum group D (XPD) gene, which plays a role in the nucleotide excision repair (NER) repair mechanism, and the expression levels of miR-145 and miR-770 genes, which play a role in the regulation of the expression of the XPD gene, in hemodialysis patients with (n = 42) and without malignancy (n = 9) in pre- and post-dialysis conditions. We also evaluated these values with the clinical findings of the patients. Gene expression analysis was performed by real-time polymerase chain reaction (qRT-PCR). Compared to the individuals with normal kidney function (2.06 ± 0.32), the XPD gene expression was lower in the pre-dialysis condition both in hemodialysis patients without cancer (1.24 ± 0.18; p = 0.02) and in hemodialysis patients with cancer (0.82 ± 0.114; p = 0.001). On the other hand, we found that miR-145 and miR-770 expression levels were high in both groups. We also found that expression levels were affected by dialysis processes. A statistically significant positive correlation was found between miR-145 and mir770 expression levels in the pre-dialysis group of patients with (r=-0.988. p = 0.0001) and without (r=-0.934. p = 0.0001) malignancy. Studies on DNA damage repair in the kidney will help develop strategies to protect kidney function against kidney diseases.

#3932 INSULIN RESISTANCE IN PEDIATRIC CKD PATIENTS

Abstract Background and Aims Pediatric chronic kidney disease (CKD) is associated with disturbance of glucose metabolism &amp; insulin receptor sensitivity leading to impaired glucose tolerance &amp; insulin resistance (IR), which are potential risk factors for cardiovascular disease (CVD). Hyperinsulinemia and IR are not extensively investigated in children with CKD, especially in different stages of CKD. The aim of our study was to detect hyperinsulinemia &amp; IR in pediatric CKD patients. Method A total of 87 children and adolescents; 58 with chronic kidney disease (CKD); (29 CKD stage 2-4, pre-dialysis group &amp; 29 CKD stage 5 on regular hemodialysis, CKD5d group) &amp; 29 age &amp; gender matched controls were enrolled in the current cross-sectional study. Homeostasis model assessment of insulin resistance (HOMA-IR) using fasting insulin &amp; glucose, where IR was considered if HOMA-IR was 4.39. Results Fasting insulin &amp; glucose hadn't significantly changed between CKD patients &amp; controls (p = 0.7, 0.3 respectively), while IR represented by HOMA-IR was found in a total of 11 (12.6%) CKD patients (6, 6.89% CKD5d &amp; 5, 5.74% CKD 2-4) with no significant difference between pre-dialysis &amp; dialysis groups (p&amp;gt;0.05), while it was significant with controls (p = 0.039), meanwhile, the total means of HOMA-IR between were no statistically significant between all CKD patients &amp; (p = 0.64). HOMA-IR correlated positively to dialysis durations (p = &amp;lt;0.001, &amp;lt;0.001 respectively), but hadn't changed with BMI. Conclusion Pre-dialysis &amp; dialysis CKD pediatric patients are at a high risk of IR &amp; hence CVD. CKD &amp; dialysis durations are independent risk factors for IR.

Better renal replacement therapy to improve sexual function in female patients with end-stage renal disease: A cross-sectional study.

Sexual dysfunction is commonly observed in patients with end-stage renal disease (ESRD). Sexual dysfunction in correlation with ESRD is associated with physiological and psychological problems resulting in low sexual desire, arousal, difficulties in achieving orgasm, and pain during intercourse. Studies on female sexual dysfunction (FSD) in correlation with renal replacement therapy are limited, and previous studies reporting contradictive results have indicated that the best modality for providing better outcomes (especially on FSD) remains unclear. Thus, this study aimed to compare the sexual function between female patients with ESRD who were on continuous ambulatory peritoneal dialysis (CAPD) and those on hemodialysis (HD). This study enrolled female patients who were randomly selected from the urology and renal division of the Internal Medicine Outpatient Clinic of our hospital from January 2020 to August 2021 and divided into the following groups: predialysis, HD, CAPD, and control groups. The participants were asked to fill out the Female Sexual Function Index (FSFI) questionnaires, and their data were recorded and analyzed using GraphPad Prism 9.0.0. Of the 280 patients, 200 female patients were included in this study. The rate of FSD (cutoff: 26.55) was 42% in the control group, 72% in the predialysis group, 62% in the CAPD group, and 66% the in HD group. The control group had a higher mean score in all parameters (p < 0.05). The total FSFI mean score indicated no significant difference (p > 0.05) between the patients on HD and those on CAPD; the mean of each point was almost identical except for satisfaction, which was higher among patients on CAPD (p < 0.05). Significant differences in the components of desire, arousal, orgasm, and satisfaction were observed between the groups. Patients on CAPD had better FSFI scores than the female patients with ESRD who were on HD, and the scores of both groups of patients were better than those of the predialysis group.

Revealing the Connection Between Hemodialysis and Sexual Physiology in Women With End-Stage Renal Disease.

In the recent past, the procedure of hemodialysis has frequently been opted for patients with end-stage renal disease (ESRD) around the globe. In such patients, the concern of sexual dysfunction is highly prevalent, which causes psychological as well as social deterioration in these patients. Wretchedly, this issue has been ignored in developing countries like Pakistan because of social and cultural constraints. Objectives: The aim was to measure and compare Female Sexual Functions of Dialysis (FSFI) scores among three comparative groups: healthy controls, pre-dialysis patients, and hemodialysis patients. A comparative cross-sectional study was carried out with 60 females aged 22-50 years in which 20 were healthy (controls) and 40 were patients with ESRD; of these 40, 20 were taking only oral medicines (pre-dialysis) and 20 were also receiving hemodialysis (hemodialysis). Married women who could read Urdu and were living with live spouses were included, and those with any psychological or psychiatric illness were excluded. Data was collected through a Likert-scaled questionnaire, Urdu translation of the FSFI questionnaire, and scores of each domain were analyzed. Single-tail one-way ANOVA was used to observe the significant difference among the three comparative groups. A strong statistical difference was observed among the hemodialysis, pre-dialysis, and healthy control groups when these three study groups were compared for the mean scores of all related domains of FSFI questtionarie. In each female sexual domain, i.e. Desire, Arousal, Lubrication, Orgasm, Satisfaction, and Pain, the diseased groups (pre-dialysis and hemodialysis) showed lower sexual scores than the healthy group. The lowest scores were observed in the pre-dialysis group (16.4 ± 6.8) and the highest were noticed in the healthy group (29.9 ± 1.8); the hemodialysis group (23.3 ± 5.0) expressed a moderate pattern of scores in each sexual domain. ESRD female patients who were receiving hemodialysis along with routine oral medications showed improved sexual physiology (with better FSFI scores) compared to those who were without hemodialysis.

Alexithymia; an often missed condition prevelant in the practice of nephrology

Aim: Alexithymia is a disorder associated with difficulty in recognizing and expressing feelings, which can lead to an increased susceptibility to disease development that makes alexithymia a possible risk factor for chronic kidney disease (CKD). This study was performed to evaluate for alexithymia in pre-dialysis CKD and end-stage renal disease patients undergoing hemodialysis.Material and Method: The study was conducted in the Nephrology Outpatient Department and Hemodialysis unit of Ümraniye Research and Training Hospital. The patients had to have a diagnosis of CKD. Demographic data form, routine biochemical follow up data of patients, Toronto Alexithymia Scale (TAS), and Hospital Depression and Anxiety Scale (HADS) were used in this study. The statistical significance level was determined as p&amp;lt;0.05.Results: A total of 111 patients (mean age 58.10±13.48 years, 61% female) were included in the study, 83.9% of whom were found to have alexithymia. The incidence of alexithymia in CDK patients was significantly higher than that in the control group (p=0.004); however, no statistically significant difference was detected in its incidence between the hemodialysis and pre-dialysis groups (p&amp;gt;0.05). The results showed that increased incidence of depression resulted in a 4.47-fold (p=0.035) increase in the incidence of alexithymia. Conclusion: Alexithymia has been found to be high in patients with chronic kidney disease. Therefore, it is essential that we be aware of patients’ emotional stress and assess them for depression, anxiety, and alexithymia.

Evaluation of apo lipoprotein A-1 and some biochemical parameters in the blood of patients with chronic kidney disease

Aim: This study was designed to determine the level of serum Apolipoprotein A-I (ApoA-I), Cystatin C, and homocysteine among three groups - CKD patients without the end- stage renal disease (ESRD), patients with ESRD on hemodialysis and healthy controls. Materials and Methods: A retrospective, hospital-based study was carried out from 100 patients&#39; records from each group and serum Cystatin-C, homocysteine, apo-A1values were noted. Results: The duration of dialysis treatment was 31 [+ or -] 35 months. Paired t-test analyses showed a significant increase in mean urea and creatinine, uric acid, and Cystatin C among CKD patients which then declined significantly after hemodialysis. Serum Apo-A1 and homocysteine levels were significantly higher in both hemodialysis and pre-dialysis groups compared to control subjects. Conclusion: HD increases apoA1 and Cystatin C whereas decreases HCM and uric acid as both are antagonists that might play a vital role in the pathogenesis of related disorders in CKD Patients.

The role of decoy receptor 3 in inflammation and atherosclerosis in patients with chronic kidney disease and renal transplant patients

IntroductionThe cardiovascular risk has been increased in chronic kidney disease associated with chronic inflammation and atherosclerosis. Decoy receptor 3, is a member of the TNF receptor superfamily and associated with inflammation and atherosclerosis. The aim of our study is to determine the relationship, between serum DcR3 levels and inflammatory markers in patients with renal transplantation, those receiving dialysis treatment and cases with chronic renal failure that did not receive replacement therapy, and to evaluate their correlation with USG findings. Material and methodsA total of 150 patients aged between 22–86 years, consisting of 4 groups, namely renal transplantation, dialysis, predialysis chronic kidney disease and control groups, were included in the study. Serum decoy receptor 3, VCAM-1, ICAM-1 and IL-8 measured with ELISA method. Carotid intima-media thickness and presence of carotis arter plaque performed by ultrasound probe, non-invasively. ResultsAll serum markers were higher in dialysis and pre-dialysis chronic kidney disease groups compared to renal transplant and control groups (p<0.05). Serum decoy receptor 3 level (median(min–max)) of renal transplant group (0.49ng/mL (0.19–1.65)) was higher than control group (0.35ng/mL (0.19–2.22)). There was no difference between patients receiving dialysis (0.89ng/mL (0.41–4.98)) and patients with pre-dialysis chronic kidney disease (0.71ng/mL (0.29–1.68)). There was no difference between patient groups in terms of the presence of plaque. ConclusionAlthough renal transplantation provides a significant improvement in the inflammatory process, not return completely. Inflammatory process associated with uremic milieu may predispose to atherosclerosis in patients with pre-dialysis chronic kidney disease and hemodialysis patients.

Lipid status and carotid intima-media thickness in patients with end-stage renal disease.

Aim To assess morphological characteristics of carotid blood vessels in uremic patients before to the initiation of the dialysis treatment, and corelate data with various dialysis therapy modules. Methods The study included 30 patients with end-stage renal disease (ERDS) prior to commencing dialysis, 30 patients treated with haemodialysis and 30 patients treated with continuous ambulatory peritoneal dialysis. The control group consisted of 15 subjects with normal kidney function (eGFR>60ml/min). Carotid intima-media thickness (CIMT), as well as lipid status values (cholesterol, triglycerides, low-density lipoprotein (LDL), high-density lipoprotein (HDL), apolipoprotein A, apolipoprotein B) were evaluated. Results The significant difference in CIMT was detected between the control and haemodialysis groups (p<0.001), and between the control and the peritoneal dialysis group (p=0.004). In patients in the predialysis group, CIMT was influenced by cholesterol (p=0.013), HDL (p=0.044), LDL (p=0.001) and ApoB (p=0.042) values. A significant difference in CIMT was proved between the haemodialysis and predialysis group of patients (p<0.001). The only variable from the patient's lipometabolic profile significantly associated with the change in IMT in uremic patients was HDL. A significant difference was found in the average value for systolic blood pressure (p<0.001) and diastolic blood pressure (p=0.018) in patients before starting the dialysis treatment compared to patients treated with other dialysis methods. Conclusion Patients on haemodialysis treatment had a significantly greater CIMT, which is in relation with a higher cardiovascular risk.

Testosterone Replacement Therapy in Chronic Kidney Disease Patients

(Background) The aim of our study was to evaluate the efficacy and safety of testosterone replacement therapy (TRT) in men with chronic kidney disease and hypogonadism on conservative and hemodialysis treatment. (Methods) The studied population consisted of 38 men on hemodialysis (HD), 46 men with CKD stages II-IV (predialysis group, PreD) and 35 men without kidney disease who were similar in age to others (control group). Serum total testosterone level (TT) was measured, and free testosterone level (fT) was calculated. Hypogonadism criteria according to the EAU definition were fulfilled by 26 men on HD (68.4%) and by 24 men from the PreD group (52%). Testosterone replacement therapy (TRT) with testosterone enanthate in intramuscular injections every 3 weeks was applied in 15 men from HD and in 14 men from PreD. The safety of TRT was monitored by measuring PSA and overhydration. (Results) A significant rise of TT and fT was observed after 3 months of TRT, but no significant changes were observed after 6 and 12 months in the HD and PreD group. An intensity of clinical symptoms of hypogonadism measured by ADAM (androgen deficiency in the ageing male) questionnaire gradually decreased, and the intensity of erectile dysfunction measured by the IIEF-5 (international index of erectile functioning) questionnaire also decreased after 3, 6 and 12 months of TRT in the HD and PreD group. (Conclusions) The applied model of TRT is effective in the correction of clinical signs of hypogonadism without a significant risk of overhydration or PSA changes.

Comparison of gastrointestinal symptoms and findings in renal replacement therapy modalities

ObjectiveChronic kidney disease (CKD) affects gastrointestinal system (GIS) and causes histological, functional and mucosal changes. There are scarce data investigating GIS symptoms and findings in patients with CKD stage III-V, receiving hemodialysis (HD) and peritoneal dialysis (PD). In this study, we aimed to evaluate the frequency of gastrointestinal symptoms and findings and compare between renal replacement therapies.MethodA total of 290 patients (97 in CKD stage III-V, 92 PD, 101 HD) were included in this study. Gastrointestinal complaints, diseases, background characteristics of patients and drugs they used were questioned by interviews, forms were filled and examinations of patients were performed. Results of upper GIS endoscopy, colonoscopy, abdominal ultrasonography and tomography of patients were evaluated.ResultsThe most common signs were dyspepsia (50%), nausea (45%) and epigastric pain (44%) among all patients, generally. Gastrointestinal disorders like gastritis (62%) and gastroesophageal reflux (39%) were frequent in patients. Prevalence of patients with weight loss was 20% in predialysis and 8% in PD and the ratio was higher in predialysis group statistically significantly (p = 0,016). The prevalence of gastritis was 70% in PD, 55% in HD and the prevalence of hemorrhoids was 24% in PD and 12% in HD. The prevalence of gastritis and hemorrhoids was higher in the PD group than in the HD group statistically significantly (p = 0.043, p = 0.028), otherwise, there wasn’t a difference between the PD and predialysis groups, statistically significantly.ConclusionThis study showed that; gastrointestinal symptoms and disorders were very common in CKD, besides this; while gastritis and hemorrhoids were more frequent in the PD, esophagitis and hiatal hernia were more frequent in the HD.

A Study of Mucocutaneous Manifestations in Patients with Chronic Kidney Disease

Background: Chronic renal failure is associated with diverse mucocutaneous manifestations as a result of underlying etiology as well as due to various treatment modalities which can significantly impair the quality of life. Aim: To study the clinicodemographic profile of Chronic Kidney Disease (CKD) patients and to compare the cutaneous manifestations in CKD both on dialysis and pre-dialysis group. Methods: This study was carried out in the Department of Dermatology, Venereology and Leprology, Medicine and Dialysis unit at Shree Krishna Hospital, Karamsad, Anand. One hundred and twenty patients with CKD were examined for mucocutaneous changes over a period of one year. The descriptive statistics was used to describe the quantitative data and the qualitative data was presented using frequency and analyzed using Chi Square test. Result: All one hundred and twenty patients had at least one mucocutaneous condition due to CRF. The most prevalent finding was xerosis (34 Pre-dialysis+ 31 Dialysis) 65(54.2%), followed by pruritus (33 Pre-dialysis+ 24 Dialysis) 57(47%), pallor (6 Pre-dialysis+21Dialysis) 27(22.5%) and cutaneous pigmentation (10 Pre-dialysis+14 Dialysis) 24(20%). Other cutaneous manifestations included fungal 10(8.3%), viral 9(7.5%) and bacterial 7(5.8%) infections, purpura 9(7.5%),perforating disorder 6(5%),uremic frost 1 (0.83%).The nail changes included onychomycosis 5(4.2%), koilonychia 4(3.3%),half and half nail 2(1.7%), subungual hyperkeratosis 2(1.7%) and onycholysis 2(1.7%). Hair changes included brittle and lusterless hair 21(17.5%), sparse scalp hair 10(8.3%) and sparse body hair 8(6.7%). Oral changes included xerostomia 15(12.2%), ulcerative stomatitis 4(3.3%) and angular cheilitis 4(3.3%). Conclusion: The most common mucocutaneous manifestations in the patients under our study were xerosis and pruritus, irrespective of hemodialysis status. Early recognition and treatment can reduce morbidity and improve these patients' quality of life. In all such patients, lifelong follow up is needed.

Patency and Complications of Arterio-venous Fistula Created in Pre- and Post-dialysis Settings.

To determine the difference in patency and complication rates of arterio-venous fistula (AVF) constructed in pre-dialysis versus post-dialysis settings. Descriptive study. The Department of Vascular Surgery, Shifa International Hospital, Islamabad from January 2014 to August 2020. Computerised record of 726 patients, who had undergone vascular access surgery for haemodialysis, was collected. Patients were divided into two groups according to those who had undergone AVF surgery: a) prior to the commencement; or b) after the commencement of haemodialysis. Primary and secondary patency rates were determined clinically by using duplex scans. Complications and suitability of AV fistula were assessed in both the groups. Data was collected and analysed using SPSS version 25, considering p-value of less than 0.05 as statistically significant. Early fistula failure was significantly higher in post-dialysis group compared with pre-dialysis group, while primary patency was higher in pre-dialysis (78.2%) group comparing with post-dialysis (66.1%) group. Secondary patency was 88.9% and 75.8% in pre- and post-dialysis groups, respectively. Early dialysis suitability failure rates were 12.2% and 15.1%; and late suitability failure rates were 7.9% and 16.1% in the pre- and post-dialysis groups, respectively. Higher rates of complications like maturation failure, low flow AVF, stenosis, thrombosis, venous hypertension, AV aneurysm, and infections were encountered in post-dialysis group compared to pre-dialysis group. Surgical creation of AVF three months prior to commencement of haemodialysis is advantageous in terms of patient outcomes and healthcare resources. However, a multidisciplinary approach and timely referral of patients to a vascular clinic further enhances the outcome with respect to the suitability of vascular access for dialysis. Arterio-venous fistula, Dialysis, Patency, Complications, Suitability.

The prevalence and potential aetiological factors associated with restless legs syndrome in patients with chronic kidney disease: a cross-sectional study.

There is limited understanding of aetiological factors of and treatment options for restless leg syndrome (RLS) in patients with chronic kidney disease (CKD). This study aimed to estimate the prevalence of RLS in CKD patients and identify factors that may contribute to RLS. A questionnaire-based cross-sectional study of patients with CKD stage 4 (CKD 4), pre-dialysis stage 5 (CKD-5ND) and haemodialysis-dependent stage 5 (CKD-5D) was conducted. Eligible patients were enrolled from the local dialysis units and renal clinics. The International RLS Study Group rating scale was used to establish the diagnosis of RLS and quantify its severity. 212 patients with CKD 4 (n = 92), CKD-5ND (n = 14) and CKD-5D (n = 106) were included. The overall prevalence of RLS was 32.1%. Women had a significantly higher odds of having RLS despite adjustment for age, diabetes, cardiovascular disease and whether patients were on dialysis (odds ratio 2.8 [95% confidence intervals 1.5-5.2]). In pre-dialysis groups, patients with RLS had significantly higher serum ferritin (323.9 [SD 338.1] vs 177.5 [SD 178.5]µg/L, p = 0.020) compared to non-RLS patients. In dialysis patients (CKD-5D), those with RLS had significantly higher total white cell (8.0 [SD 3.5] vs 6.8 [SD 1.9] × 109/L, p = 0.026) and neutrophil (6.4 [SD 3.9] vs 4.6 [SD1.7] × 109/L, p = 0.002) counts compared to patients without RLS. RLS remains a significant problem in patients with CKD and may be related to underlying inflammation. Targeting this pathway may be useful. Prevalence of RLS, diagnosed using validated measures, is higher than previous reports. N/A (the current study is not a trial).

Hepatocyte Growth Factor in Predialysis and Hemodialysis Chronic Kidney Disease Patients.

Chronic kidney disease (CKD) which is characterized by progressive loss of renal function and renal fibrosis is a worldwide public health problem. Hepatocyte growth factor (HGF) is a polypeptide that exhibits multiple functions including antifibrotic effects on kidneys. The present study was aimed at evaluating HGF levels and studying its association with markers of inflammation and oxidative stress in patients of predialysis and dialysis CKD. A total of 80 subjects including 20 healthy controls, 40 patients of CKD stage 1 to stage 5 (predialysis), and 20 CKD patients with end-stage renal disease on hemodialysis were recruited. HGF, high-sensitivity C-reactive protein (hsCRP), malondialdehyde (MDA), and ferric reducing ability of plasma (FRAP) were measured in all the subjects. HGF levels were significantly higher in all patients with CKD compared to controls. The levels were found to be lower in patients on dialysis than in the predialysis group; however, the difference was not statistically significant. hsCRP, MDA, and FRAP were significantly higher in all patients with CKD than in controls. HGF levels did not show a significant correlation with the markers studied. HGF levels were increased in response to renal injury in CKD patients. The levels were higher in predialysis patients of CKD than in CKD patients on dialysis. HGF levels may be used as an indicator of renal fibrosis in patients with CKD.