Background Dialysis adequacy is an important and effective factor in reducing mortality and morbidity among patients with end-stage kidney disease. This study aims to assess the current clinical situation of hemodialysis (HD) patients, to monitor the established quality-of-care indicators, and to identify the unachieved quality-of-care goals. Patients and methods This is an observational study in which all patients underwent chronic HD program (>1 year) at the nephrology center in Benghazi, Libya. It was conducted between January and June 2018. Mean levels were collected for the following indicators: hemoglobin, dialysis dose, serum calcium and phosphorus, parathyroid hormone, systolic and diastolic blood pressure, interdialytic hypotension, and vascular access. Results A total of 292 dialysis patients were reviewed and followed over a 6-month period. Overall, 170 (58.2%) were males and 122 (41.8%) were females. Mean age was 51.1±14 years. Hypertension was the most common cause of end-stage kidney disease in 76 (26.0%) patients followed by diabetes mellitus in 32 (11.0%) patients. Our patients failed to achieve adequate HD, as laboratory value results were as follows: mean hemoglobin level less than 10 g/dl in 61% of patients, serum Ca⁺² was less than 8.4 mg/dl in 48.6%, serum PhO₄ was more than 5.5 mg/dl in 50%, and serum parathyroid hormone was more than 300 ng/dl in 60.3%. Conclusion Dialysis insufficiency was seen in a significant percent of patients in this study. More extensive research studies for finding the causes of low dialysis quality are suggested.

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Background Chronic kidney disease (CKD) is a leading global health threat. In Pakistan, age-specific prevalence of CKD is reportedly 43.6% among elderly (>50 years) and 10.5% among younger population (<30 years). A number of hematological parameters have been shown to be affected in patients with CKD and are associated with anemia, coagulopathy, and leukocyte dysfunction. The objective of the research study was to characterize the hematological profile identified in patients with CKD. Patients and methods In this cross-sectional study, 156 patients with end-stage renal disease (ESRD) were enrolled. Demographic details including age and sex and brief medical history were obtained. Medical records of the patients were also reviewed. In addition, upon obtaining written informed consent, venous blood sampling was performed by a professional phlebotomist, and results were acquired. The hematological profile was documented through predesigned proforma. Results The mean age of patients was 47.59±5.87 years. There were 114 (73.1%) male and 42 (26.9%) female patients in this study. Overall, 96 (61.5%) patients with ESRD had diabetes mellitus (DM), 89 (57.1%) had hypertension (HTN), and 65 (41.7%) had active smoking history. The average duration (months) of ESRD in patients was 15.5±2.4, mean hematocrit (%) was 23.8±3.2, hemoglobin (g/dl) was 8.7±3.1, erythrocyte sedimentation rate (ESR) (mm/h) was 94.2±43.2, platelet count (cells/l) was 147×10⁹±65×10⁹, white blood cell count (cells/l) was 7654.8±3947.4, neutrophil (%) was 67.3±14.6, lymphocyte (%) was 30.5±14.2, and eosinophil (%) was 6.2±2.2. The hematological profile also revealed that 144 (92.3%) patients had anemia, 128 (82.1%) had elevated ESR, 25 (16%) had thrombocytopenia, 30 (19.2%) had leukocytosis, and 19 (12.2%) had eosinophilia. When we stratified hematological profile of patients with ESRD regarding age, sex, DM, HTN, smoking status, and duration of ESRD, we found a significant correlation with respect to age (elevated ESR and thrombocytopenia), sex (anemia, elevated ESR, thrombocytopenia, and eosinophilia), DM (elevated ESR), smoking status (thrombocytopenia and leukocytosis), and duration of ESRD (thrombocytopenia and leukocytosis) (P<0.05). No relationship was witnessed between hematological abnormalities and HTN. Conclusion Our study demonstrated that anemia is a predominant clinicolaboratory manifestation in patients with CKD along with elevated ESR, thrombocytopenia, leukocytosis, and eosinophilia. A statistically significant correlation was observed between hematological abnormalities in patients with ESRD and age, sex, DM, smoking status, and duration of ESRD.

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Background Although risk factors for diabetic foot ulceration have been extensively studied in patients with diabetes in Egypt, there is surprisingly limited evidence among those on chronic hemodialysis (CHD). The study aimed to scrutinize the risk factors for foot ulceration in adult patients with diabetes with end-stage renal disease on hemodialysis in Dakahlia Governorate central hemodialysis units. Patients and methods This cross-sectional study included all diabetic patients under CHD aged more than or equal to 18 years (n=98), recruited over 7 months from the largest seven central hemodialysis units in Dakahlia Governorate, Egypt. Data collection consisted of a participant interview, medical record review, and noninvasive comprehensive foot examination. The assessment included peripheral neuropathy, peripheral arterial disease, other foot pathologies, footwear, and foot health care behavior. Results The study included 57 males and 41 females. The median duration of diabetes was 15 (2–33) years. Overall, 61 (62.2%) patients were on insulin therapy. The median duration of hemodialysis was 3 years. Insensate neuropathy and peripheral arterial disease were detected in 65.3 and 15.3% of patients, respectively. The prevalence of foot deformities was 18.36%. Plantar calluses and dry skin were diagnosed in 27.6 and 62.2% of patients, respectively. A total of two (2.04%) patients had active foot ulcers and nine (9.18%) patients had ulcers in remission; therefore, the overall diabetic foot ulceration prevalence was 11.22%. In addition, 10 (10.2%) patients had previous minor amputations, with no reported major amputations. Overall, 95.92% had poor foot health care behaviors, and 81.63% were using inappropriate footwear. None of the included patients previously used custom-made insoles. Conclusions The key finding of this article suggests a high prevalence of risk factors for foot ulceration among diabetic patients receiving hemodialysis. Diabetic foot screening should be included in the management strategy of those on CHD.

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With increasing numbers of renal transplants performed globally, there is also an increase in the incidence of patients with failed transplants. Management of these patients with a failed graft needs special attention, as they represent a unique patient cohort with specific medical issues and high degree of morbidity and mortality. The primary aim should be to prolong the function of the existing graft and plan for eventual return to dialysis or early retransplantation. Minimization of immunosuppression to avoid unnecessary adverse effects while stabilizing cardiovascular risk factors and associated comorbidities is paramount. Individualized decision making is required in terms of graft nephrectomy versus leaving the graft in situ. Furthermore, an informed decision needs to be taken regarding the optimum plan of definitive management in terms of return to dialysis, retransplantation, or conservative management.

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The birth of distance learning courses in nephrology was set up in Mansoura (Mansoura Nephrology Club) in 2005. This activity was endorsed by the Egyptian Society of Nephrology and Renal Transplantation (ESNT) in early 2006. Tele-education was restricted to sharing presentations and the facilities to ask the experts. All questions and answers were uploaded to the website. The year 2012 witnessed a revolution in the ESNT continuous medical education chapter to include outreach programs followed by the ESNT virtual academy takeoff, with evolving experience through the following years, including enormous amounts of presentations, conferences, assignments, quizzes, as well as the full curriculum of Mansoura Nephrology Doctorate degree. More than 28 000 users from all continents and countries use this service on a daily basis. From May 2019, the ESNT activated online webinars to ensure interactive teaching that extended to a real Tele-medicine and teleconsultation to improve nephrology practice. In coronavirus disease 2019 era, where social distancing has become a necessity, the ESNT in collaboration with the international nephrology experts adopted a very active international distance nephrology education. A total number of 4596 lectures as well as links to 1850 videos are free of charges for all nephrologists all over the world, making ESNT virtual academy one of the largest open-source nephrology educational facilities.

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Background Early detection of vascular access complication prevents more severe conditions and reduces hospitalization periods of patients on regular hemodialysis (HD). Access recirculation (AR) is one of the tools for early evaluation of arteriovenous fistula (AVF) complication for early intervention. The aim of our study was to evaluate the AV AR as a risk factor for inadequate HD in patients with end-stage renal disease in Menoufia university hospitals. Patients and methods This is a cross-sectional study that included 300 patients on regular HD sessions at four centers at Menoufia university hospitals. All patients were subjected to detailed history taking, clinical examination, laboratory investigation, and measurement of recirculation by urea-based method. Results This study included 300 patients on regular HD. It showed that 51.7% presented with aneurysm, whereas the infected AV access was presented in 6% of patients. AR was found in 17.7% of patients, being more frequent in patients with the left brachiocephalic AVF (37.7%), and it showed highly significant relation with duration of dialysis and duration of AVF creation. The risk factors for recirculation were the distance between arterial and venous needle sites, puncture site aneurysm, and stenosis. There were negative correlations between AR and both urea reduction ratio and KT/V and positive with both serum potassium and parathyroid hormone level. Conclusion AR in our unit was associated mainly with stenosis, aneurysm, and improper needle puncture sites, so screening for recirculation may be used as a surveillance technique for the early detection of AVF in concomitant with regular training of dialysis staff in cannulation of the AVF.

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Background Patients with IDHTN have an increased risk for hospitalizations and mortality. The pathogenesis of IDHTN is not well understood. Hypoxemia is thought to stimulate the blood pressure (BP) elevation. The aim of this work was to study the changes of the arterial oxygen saturation (SaO₂) during hemodialysis (HD) and their relations to intradialytic hypertension (IDHTN). Patients and methods This is a prospective observational study that analyzed SaO₂ and BP changes during HD sessions in 75 regular HD patients over 6 months. Patients were divided into two groups: group A included patients without intradialytic hypertension (non-IDHTN) and group B included patients with persistent IDHTN group. Results Group B patients had significantly lower predialysis, intradialytic, and postdialysis SaO₂ levels compared with group A (P<0.001). Group B patients also showed a significant drop in intradialytic SaO₂ compared to group A (P<0.001). There were significant negative correlations between the predialysis, intradialytic, and postdialysis SaO₂ and intradialytic systolic blood pressure elevation (P<0.001). It was found that the reduction of the predialysis and intradialytic SaO₂ less than 92.5 and 90.5%, respectively, could be predictors of intradialytic systolic blood pressure increase (P<0.001). Conclusion Decreased SaO₂ before and during HD sessions may be involved in the induction of IDHTN.

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Background Although cytopenia is common during the first few months following transplantation owing to induction and maintenance immunosuppressant, little is known about the prevalence of cytopenia in transplant patients beyond the first 6 months after transplantations. Thus, we conducted the present study to investigate the prevalence of chronic cytopenia in renal transplant recipients. Patients and methods This was a cross-sectional descriptive study carried out on 81 kidney transplant recipients in the renal transplant clinic at Sohag University Hospital during the period from February 2018 to February 2019. A nonprobability consecutive sampling technique was employed to recruit eligible patients. Results Regarding study outcomes, we found that 44.4% of our study group had anemia, 38.3% had normocytic anemia, and 6.2% had microcytic anemia. Regarding the degree of anemia, 17.3% of the patients had severe anemia, 17.3% had mild anemia, and 9.9% had moderate anemia. In addition, 3.7% of the study groups had leukopenia and 1.2% had leukocytosis. Regarding platelets, only one (1.2%) patient had thrombocytosis. Conclusion Chronic posttransplantation cytopenia is a common complication after kidney transplantation, especially anemia. Therefore, it is recommended that physicians involved in renal transplantation consider the investigation and follow-up of transplant recipients for posttransplantation cytopenia and adopt appropriate preventive and therapeutic measures. In addition, we recommend further studies on a larger number of patients, with focus on the link between posttransplantation cytopenia and mortality.

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Background Anti-glomerular basement membrane (GBM) disease is an autoimmune disorder defined by the presence of autoantibody directed against α3 chain of type IV collagen. It is clinically characterized by rapidly progressive glomerulonephritis and lung hemorrhage. Patients and methods A retrospective study of 25 patients with anti-GBM disease, who were diagnosed and followed up at our institute from January 2011 to December 2017, was undertaken. Most patients presented with hypertension (76%), oliguria (80%), and dialysis-dependent renal failure (96%). Hemoptysis was seen in only one-third (28%) of patients. Diffuse glomerulosclerosis with crescents was the most common renal histopathology (60%) seen. Results Of all patients who were able to get adequate treatment in the form of plasmapheresis (56%) and immunosuppression (100%), only one (4%) patient recovered. Conclusion The majority of our patients with anti-GBM presented late in their clinical course of the disease, with advanced renal failure and irreversible lesion on kidney biopsy. High index of suspicion, early diagnosis, and aggressive management may improve the outcome of these patients.

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