Introduction Muslims fast during the whole lunar month of Ramadan from dawn to sunset. Some studies have evaluated the effect of the different patterns of intermittent fasting including Ramadan fasting (RF) on the perception of fatigue, mood, and cognitive functions in healthy individuals and in some patient groups, but the effect of RF on the perception of fatigue, mood, and cognitive functions was not assessed previously in patients with chronic kidney disease (CKD). Aim This study aimed to evaluate the effect of RF on fatigue, depressed mood, anxiety, and cognition in a cohort of old Egyptian CKD patients who fulfilled fasting during the whole month of Ramadan. Patients and methods This was an observational pilot study that included 20 CKD patients (eight men and 12 women), mean age 61.9 years, who fasted during the whole lunar month of Ramadan. Fatigue, mood, and cognition were assessed using standardized questionnaires before and after RF. Complete blood count, serum creatinine, estimated glomerular filtration rate, serum albumin, body weight, BMI, and body composition assessed by bioimpedance analysis were determined within a week before and within a week after RF. Results RF was associated with significant worsening of fatigue (P=0.001), depressed mood (P<0.000), and cognition (P<0.000), whereas anxiety was not significantly changed (P=0.163). RF was not associated with a significant change in creatinine (P=0.132), estimated glomerular filtration rate (P=0.097), or albumin (P=0.352). RF was not associated with a significant change in body weight (P=0.445) BMI (P=0.168), body fat (P=0.979), muscle mass (P=0.662), or body water (P=0.815). Conclusion RF is associated with significant worsening of fatigue, mood, and cognition in old CKD patients. RF had no significant effect on renal function tests or body composition in these patients.

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Introduction Chronic kidney disease is a universal escalating health issue of many etiologies. It affects millions across the world from all racial and ethnic groups. Objective The purpose of this study is to assess the influence of erythropoietin (EPO) therapy on glycated hemoglobin (HbA1c) levels while excluding conditions that cause changes in the blood glucose concentration. Patients and methods Clinical data were collected from 60 Egyptian patients with chronic kidney disease; of these, 30 patients had a history for diabetes mellitus and 30 nondiabetic controls. Serum urea, creatinine, complete blood count, fasting and postprandial blood glucose levels, and HbA1c were measured by means of column chromatography before and 3 months later after a course of recombinant EPO treatment for anemia. Results This study revealed that EPO medication had a significant effect on HbA1c levels, and the more erythropoiesis fluctuated by altering the dose of EPO, the more HbA1c levels changed, though there were no significant changes in blood glucose levels throughout the study period. The changes in HbA1c during the 3-month period were inversely correlated with the changes in Hb%. Conclusion The change in Hb% should be kept in mind when the HbA1c level is evaluated in EPO-treated patients and formula should be proposed to correct HbA1c levels based on the change in hematocrit or the reticulocyte count.

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Objectives Cystatin C is an alternative parameter for the assessment of renal function. The objective of the study is to evaluate the efficacy of serum cystatin C as a marker of renal dysfunction among different chronic kidney disease (CKD) and postrenal transplant patients. Patients and methods A total of 60 postrenal transplants patients and 60 patients with CKD were compared with 30-old aged patients regarding serum cystatin and through evaluating cystatin-based estimated glomerular filtration rate (eGFR) and creatinine-based eGFR equations versus measured GFR using ^99mTc diethylene-triamine-penta-acetate method. Results Serum cystatin is significantly higher in the CKD group. Cystatin is negatively correlated with measured GFR in all groups, with P value less than 0.01, serum cystatin is a better parameter than serum creatinine to rule out renal dysfunction (sensitivity 95.1 and 80.3%, respectively). Cystatin eGFR (Larsson equation) has less sensitivity and specificity than creatinine eGFR formulae namely modified diet in renal disease and Gault–Cockcroft. Conclusion Serum cystatin C is a useful parameter in recognizing individuals with early renal impairment and can be used as a screening tool with significant performance

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Objective Cytomegalovirus (CMV) is one of the most frequent viral pathogens that results in post-transplantation infection. Universal prophylaxis and preemptive therapy have long been used to prevent and treat CMV infection, respectively, in post-transplantation cases. The aim of this study was to compare the universal prophylaxis with valganciclovir versus preemptive therapy in minimizing the risk of CMV infection and disease in high-risk and intermediate-risk kidney transplant recipients. Patients and methods This single-center, retrospective cohort study enrolled 63 kidney transplant recipients between March 2017 and January 2018. The outcome variables were occurrence of CMV infection and CMV disease, 1-year estimated glomerular filtration rate (eGFR), allograft rejection, allograft loss, and mortality within the first year after transplantation in high-risk (D+/R−) patients managed with universal prophylaxis of oral valganciclovir and intermediate-risk (D+/R+ or D−/R+) patients receiving preemptive treatment. Results Of the 63 kidney transplant recipients, 19 (30.2%) were grouped as high risk for CMV infection/disease and 44 (69.8%) were intermediate risk for CMV infection/disease. The average duration of post-transplantation follow-up was 349 (SD 136) days in the high-risk cohort and 335 (SD 112) days in the intermediate-risk cohort (P=0.56). CMV infection was found in 15 (34.1%) of the 44 intermediate-risk patients receiving preemptive therapy and in four (21.1%) of the 19 high-risk patients receiving universal prophylaxis (P<0.01). CMV disease developed in seven (15.9%) of the 44 intermediate-risk patients and in one (5.3%) of the 19 high-risk patients (P<0.01). Allograft rejection was found to be higher in intermediate-risk group than in high-risk group (18.2 vs. 15.8%, P=0.44). Allograft loss and mortality were also comparable between the intermediate-risk and high-risk cohorts (13.6 vs. 10.5%, P=0.54 and 0 vs. 0%, P=0.15, respectively). The mean eGFR at 1 year after transplantation was similar in both the cohorts: intermediate-risk (52.5±21.8) and high-risk (54.3±23.2) (P=0.68) cohorts. Conclusion Intermediate-risk (D+/R+ or D−/R+) kidney transplant recipients receiving preemptive therapy had significantly higher frequency of CMV infection/disease than high-risk (D+/R−) kidney transplant recipients receiving oral valganciclovir universal prophylaxis during early post-transplantation period. No statistically significant differences were found in relation to allograft rejection, allograft loss, eGFR, and mortality at 1 year in both the cohorts.

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Background Despite the estimation of glomerular filtration rate (GFR) being the best index of kidney function, and estimated glomerular filtration rate (eGFR) being limited by differences in creatinine generation among different age groups, the data regarding the accuracy of serum creatinine-based formulae on the geriatric population is still scarce. Aim Our aim is to investigate the accuracy of the eGFR equations to predict renal function in geriatric population versus the measurement of true GFR by diethylenetriaminepentaacetic acid (^99mTc-DTPA). Patients and methods The study included 160 elderly persons, with 93 (58%) females. All persons were from Minia Governorate, Egypt. GFR was estimated using Modification of Diet in Renal Disease, abbreviated Modification of Diet in Renal Disease, Walser, Nankivell, Cockcroft–Gault, Mayo Clinic, and Chronic Kidney Disease Epidemiology Collaboration. The true GFR was determined for all participants with ^99mTc-DTPA. Results All the seven eGFR estimations correlated with ^99mTc-DTPA clearance (P<0.05), but their r² was low, ranging from 0.69 to 0.54. Their respective r² values were as follows: Modification of Diet in Renal Disease 0.69, Chronic Kidney Disease Epidemiology Collaboration 0.63, abbreviated Modification of Diet in Renal Disease 0.62, Cockcroft–Gault 0.58, Mayo Clinic 0.55, Walser 0.55, and Nankivell 0.54. Conclusion In the geriatric population, the overall performance of these seven prediction equations did not give a precise assessment of kidney function, that is, all analyzed formulae lacked the precision to estimate true GFR.

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Objective Patients with hematological disorders whether benign or malignant are at high risk for acute kidney injury (AKI), which is associated with high morbidity and mortality. We sought to appraise the frequency, predictors, and outcome of AKI in a large cohort study of patients with hematological disorders. Patients and methods A prospective, observational database was undertaken at a tertiary referral hematological and oncological center hospital. We collected the medical data of in-hospital patients with AKI and hematological disorder between July 2016 and September 2018 who met the criteria for RIFLE (risk, injury, and failure; loss; and end-stage kidney disease) classification and were followed up by a nephrologist. Results According to RIFLE criteria, 137 (28.5%) patients had AKI. Overall, 35.8% of patients with hematological disorders and AKI were admitted into the ICU. Moreover, 23.4% of the patients with hematological disorders and AKI died, and only 8.4% of the survivors with AKI received renal replacement therapy. Mortality in patients with AKI in hematological disorders was associated with the presence of malignant hematological diseases (odds ratio: 5.36 and P=0.001), underlying kidney diseases (odds ratio: 1.35 and P=0.001), and occurrence of tumor lysis syndrome (odds ratio: 2.87 and P=0.001). Conclusions AKI in patients with hematological disorders, both benign and malignant disorders, is not uncommon and is associated with increased rates of ICU admission and mortality.

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