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   Table of Contents - Current issue
April-June 2018
Volume 18 | Issue 2
Page Nos. 27-58

Online since Tuesday, September 4, 2018

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Pancreatic transplantation for diabetic patients with end-stage renal failure: a brief review p. 27
Fakhriya Alalawi, Ajay Sharma, Ahmed Halawa
Renal transplant, undoubtedly, is the most physiological renal replacement therapy for patients with end-stage kidney disease (ESRD). It enhances patient’s quality of life and improves expectancy when compared with dialysis therapy. However, diabetic kidney transplant recipients can have progressive diabetic nephropathy in renal allograft and other complications of diabetes resulting in relatively inferior patient and graft survival in comparison with nondiabetic patients with ESRD. Currently, the pancreatic-kidney transplant has proven to be a very good option in selected patients with ESRD with type-1 diabetes mellitus, that is, insulin-dependent diabetes mellitus, and further smaller number of patients with ESRD with type-2 diabetes mellitus, that is, noninsulin-dependent diabetes mellitus. The aim of pancreatic transplantation is to enhance the quality of life, improve allograft and patient survival and to reverse some of the microvascular complications associated with diabetes.
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Does brain-derived neurotrophic factor play a role in depression in hemodialysis patients? Highly accessed article p. 34
Montasser M.H Zeid, Akram A Deghady, Osama A Elkholy, Yasmine S Naga, Eman M.M Farag
Background Many end-stage renal disease (ESRD) patients undergoing hemodialysis (HD) suffer from depressive disorders as well as anxiety. These often underdiagnosed conditions not only decrease the quality of life of patients but also increase their mortality. Decrease in brain-derived neurotrophic factor (BDNF) has emerged as a marker of depression that can be used for the diagnosis and follow-up of depression in the general population. Objectives The aim of the present study was to study the role of BDNF in depression in HD patients. Patients and methods A single-center, cross-sectional study was carried out including 50 depressed (group I) and 35 nondepressed (group II) ESRD patients on maintained HD according to the Hospital Anxiety and Depression Scale. BDNF levels were measured in all patients. Result The mean BDNF level was significantly lower in depressed HD patients (2556.0±1498.15 pg/ml) in comparison with group II (9017.14±4249.60 pg/ml), with a P value less than 0.001. Serum BDNF level was also correlated negatively with both the anxiety (rs=−0.440, P<0.001) and the depression score (rs=−0.693, P<0.001) in the total sample. In addition, BDNF was a significant predictor of depression with a high area under the receiver operating characteristics curve (ROC curve) (AUC) (95% confidence interval=0.939–0.998, P<0.001). Conclusion Anxiety and depression are closely linked in ESRD patients. BDNF is significantly lower in depressed HD patients and correlates negatively with both depression and anxiety. It is a useful biomarker in the detection of depression, a common often undiagnosed and undertreated condition, in ESRD.
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Effect of recombinant human erythropoietin treatment on left ventricular hypertrophy and cardiac function in dialysis patients p. 40
Ayman M El-Badawy, Ahmed E Mansour, Rasha O Abdelmoniem, Asmaa El-Seedawy Rabee
Background Cardiovascular disease is a significant complication in chronic kidney disease and a major cause of death in dialysis patients. Anemia is associated with reduced survival in patients with renal disease, and anemia is independently associated with an increased risk of cardiovascular disease. The body adapts to anemia by increasing cardiac output, which may result in cardiac remodeling and progression of left ventricular (LV) growth. Aim The aim of this study was to shed light on the effects of correction of anemia after therapy with recombinant human erythropoietin (rHuEPO) on left ventricular hypertrophy (LVH) and consequently LV function in dialysis patients. So we studied 40 hemodialysis patients with hemoglobin (Hb) less than 10 g/dl as well as 10 age-matched and sex-matched hemodialysis patients with Hb more than 11 g/dl who never received erythropoietin as a control group. Patients and methods All participants of the study were subjected to full medical history, thorough medical examination, and investigations including complete blood count, serum ferritin, and echocardiography. Results A significant increase in Hb, packed cell volume (PCV%), and red blood cells (RBCs) count was seen at all months of the study period, with mean Hb at the start of the study being 7.96±0.72 g/dl and at the end of treatment being 10.67±0.83 g/dl. There is a significant increase in ejection fraction (EF%) with significant reduction in left ventricular mass index (LVMI) after treatment in comparison with pretreatment, which means improvement of cardiac function and reduction of LVH after treatment with rHuEPO. Conclusion This prospective study showed that correction of anemia with rHuEPO in the patients undergoing hemodialysis with Hb level less than 10 g/dl led to correction of LVH, with improvement of the cardiac function.
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Serum changes in fibroblast growth factor-23 and in parameters of phosphorus metabolism after renal transplantation p. 46
Effat A.E. Tony, Mohamad A Sobh, Madleen Adel A Abdou, Mohamad F Ali
Background Kidney transplantation is the preferred treatment for chronic kidney disease, but its effect on disordered mineral metabolism is incompletely understood. Post-transplant mineral bone disease (MBD) is an important complication, although its etiology and course vary. Fibroblast growth factor (FGF23) controls phosphate and vitamin D metabolism, and its assessment increases our understanding the pathogenesis of post-transplant bone disease. Aim To determine the regulation of serum FGF23 in relation to other biochemical parameters in our post-transplant participants with preserved renal function. Materials and methods A case–control study conducted on 48 kidney transplant recipients, with age ≥ 18 years old and an estimated glomerular filtration rate (eGFR) > 60 ml/min/1.73m2, from the different transplantation centers during their follow-up from 2015 to 2016. They classified in equal number according to their post-transplant follow-up period into: group A; early 6 months, and group B; late 6 months. In addition, 20 healthy persons were enrolled in the study as controls. Patients with graft rejection at the time of enrollment, those with infections and neoplasms or taking medications were excluded. Participants subjected to full history taking and clinical examination. Peripheral hemogram, blood glucose, lipid profile, liver function, kidney function, urine analysis, calcium, phosphorus, parathyroid hormone (PTH), 25-hydroxyvitamin D, FGF23, and 24-h urinary phosphorus were done. Results Significantly high levels of FGF23, PTH, and urinary phosphorous (108.6±92.7 pg/ml, 150.7±51 pg/ ml, and 1170.5±331.1 mg/day with P<0.001 for each) with significant low levels of serum phosphorus and vitamin D3 (2.5±0.9 mg/dl and 21.1±11.4 ng/ml with P<0.001 for each) in early 6-month post-transplant period were found in our patients. However, Nearly equal non-significant levels of corrected serum calcium were found throughout the study. Multivariate linear regression analysis showed significant associations of FGF23 with eGFR and other mineral bone indices in patients groups, with P˂0.05. Receiver operating characteristic curve showed that PTH of high sensitivity and specificity (95.83 and 83.33%, respectively) and phosphaturia of high sensitivity but low specificity (91.67 and 58.33%, respectively) not FGF23 (had low sensitivity and specificity (54.17 and 33.33%, respectively) could be considered as independent markers to regulate MBD in the early post-transplant period. Conclusion FGF23 may play a role in the pathogenesis of MBD in post-transplanted patients. Although, significant associations of FGF23 with other conventional bone mineral indices in early 6-month post-transplant period were confirmed, it could not be considered as an independent marker to regulate MBD in the early post-transplant period. Future prospective studies with larger numbers of transplant recipients are required to establish its direct relationship with development or severity of MBD.
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Cytomegalovirus prophylaxis, customization of international guidelines p. 57
Mohamed E Elrggal, Yasser Elsayed Matter
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