Background Children with chronic kidney disease (CKD) have multiple risk factors for anemia such as primary erythropoietin deficiency, blood loss, decreased red blood cell (RBC) survival, bone marrow suppression, iron deficiency, inflammation and infection, malnutrition, hyperparathyroidism, vitamin B12 and folate deficiency, aluminum toxicity, and carnitine deficiency. This study was performed to evaluate the effect of oral bovine lactoferrin on patients with iron deficiency with CKD stages 2–4. Patients and methods This follow-up cohort clinical study was conducted on children with CKD in the conservative clinic, Pediatric Nephrology Unit, Children’s Hospital, Ain Shams University. It included 45 pediatric patients with CKD stages from 2 to 4 for 6 months without a control group. This is a follow-up case study in which all the included patients were on erythropoietin therapy ranging from 150 to 300 IU/kg once per week. The patients were subjected to history and laboratory evaluation, including hemoglobin (Hb), serum iron, serum ferritin, and total iron-binding capacity (TIBC), which were done for the patients at baseline and 6 months after treatment with bovine lactoferrin for 6 months. Results Blood Hb and RBC volume were significantly increased beginning from first month after oral lactoferrin therapy, serum iron and serum ferritin were significantly increased 6 months after intervention, and serum TIBC was significantly decreased after intervention. The current study had shown no significant difference between males and females regarding laboratory changes 6 months after intervention. Laboratory improvements were significantly lowest among cases with stage 4, followed by stage 3, and the highest among cases with stage 2. There was a decrease in all anemia clinical manifestations after 6 months of lactoferrin administration; the differences were significant only in easy fatigability, constipation, and gastrointestinal upset, which were the most frequent adverse effects. Conclusion Oral lactoferrin was found to be effective in treating iron-deficiency anemia regarding blood Hb, blood RBCs, serum iron, serum ferritin, and TIBC in association with erythropoietin therapy. The effect declines with the progression of CKD.

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Background Vascular access-related infections (VARI) represent a substantial burden for patients undergoing hemodialysis (HD) that is unfortunately inevitable. The spectrum of causative organisms varies between different regions and centers, so it is necessary for each dialysis unit to have its database. This prospective descriptive multicenter study was conducted over a 6-month duration to delineate the pattern of VARI among patients undergoing HD units of Alexandria University Hospitals, and to determine the possible relationship between VARI, type of vascular access, pattern of causative organisms, and various risk factors. Materials and methods The study enrolled all patients with documented clinical and bacteriological evidence of VARI. Infection incidence-rate event/1000 dialysis session (ds) was calculated. Results During the study period, 877 HD patients were approached. A total of 66 VARI episodes were identified in 62 patients, with 58 bloodstream infection (BSI) episodes and 8 local-access infections, with an overall incidence rate of 4.64/1000 ds. About 64% of isolated organisms were Gram-negative bacilli, 33.3% Gram-positive cocci, and 2.8% fungi. The most frequent isolated pathogens were Klebsiella pneumonia, Escherichia coli, and methicillin-resistant Staphylococcus aureus (MRSA). Conclusion VARI rate was higher in HD patients with temporary central venous catheter compared with permanent tunneled catheters. Gram-negative microorganisms and MRSA were the most frequent identified organisms. Creation of arteriovenous fistula should not be delayed to avoid the use of temporary catheters, which carry high risk of VARI.

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Background Hyperphosphatemia is a frequently encountered and difficult-to-manage problem in hemodialysis (HD) patients and is an important risk factor for cardiovascular diseases. This study was carried out to explore the effect of nutritional education on the serum phosphorus level in HD patients. Patients and methods This open-label, single-center randomized controlled trial involved 100 HD patients. Patients were randomly assigned to one of two groups: the education group underwent a 12-week nutritional education program, whereas the control group received standard treatment. Nutritional education was provided by a trained renal dietitian in the form of educational sessions, brochures, audiovisual teaching aids, and patient-tailored dietary recommendations. Detailed nutritional and laboratory tests were done before randomization and 3 weeks after the end of the study. Results Serum phosphorus level and calcium–phosphorus product were significantly lower among the education group (P=0.02 and 0.04, respectively) with a percent reduction of serum phosphorus of -13.8 ± 21.41 after nutritional education. Nutritional education (B: -0.57, 95% confidence interval: -1.13 to -0.01, P=0.04) and the dietary protein intake (B: -0.47, 95% confidence interval: -0.94 to -0.003, P=0.04) were the predictors of serum phosphorus level at the end of the study. Three weeks after termination, BMI, waist circumference, and malnutrition inflammation score were lower (P=0.04, 0.04 and 0.02, respectively), whereas midarm muscle circumference was higher (P=0.004) among the education group. Conclusion Nutritional education can help in controlling the serum phosphorus level in HD patients without causing derangements in the nutritional status and should be provided in each HD unit.

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Background Diabetic nephropathy is the major complication of diabetes and is one of the leading causes of end-stage renal disease. Early identification of nephropathy is crucial to slow down this process. Assessment of albuminuria is used as an early clinical marker for impaired kidney function. The aim of this study is to evaluate the magnitude of microalbuminuria (MA) in children with type 1 diabetes and determine the factors correlated to it. Patients and methods A cohort study that was carried out on diabetic children attained the endocrinology clinic in our hospital from August 2019 to October 2020. Children aged 6–18 years old with a history of 2 years of diabetes were subjected to history, examination, and investigation, including urea, creatinine, lipid profile, hemoglobin A1c, and 24-h urinary albumin were done twice. Statistical analysis used χ², Fisher exact, and independent Wilcoxon t test for comparison between groups. Spearman and Pearson’s for correlations. Results The median (interquartile range) of MA in the first visit was 10 mg/24 h (6.15–20 mg/24 h) in the first visit versus 9.5 mg/24 h (4.9–23.55 mg/24 h) in the second visit, with an insignificant P value. The abnormal numbers of hemoglobin A1c in the first visit were 85.7 and 79.3% in the second visit; P value is 0.350. Children with abnormal MA were 13.2% in the first visit versus 20% in the second visit with only four patients having persistent MA. MA was positively correlated to the Tanner stage in the first visit to blood pressure, serum triglyceride, and Tanner stage in the second visit, and negatively correlated to high-density lipoprotein. Conclusion Most of our patients had uncontrolled diabetes with an increasing prevalence of MA over time.

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Background Cardiovascular mortality is high in patients on maintenance hemodialysis. Different factors and plausible mechanisms have been explained for the increased risk. A recent concept of iron dysregulation and the related biomarker serum hepcidin was thought to be one of the novel markers of cardiovascular disease. We undertook this study to study the fatal and nonfatal cardiovascular events in dialysis population. Patients and methods All the patients who satisfied inclusion criteria were included in the study. All the patients have been on either twice-/thrice-weekly dialysis with polysulfone membrane of 1.3-m² surface area. Serum hepcidin levels were estimated in blood samples using the appropriate techniques. All the patients were followed up for 18 months to assess the fatal and nonfatal cardiovascular outcomes. Results A total of 80 patients satisfied the criteria and were followed up. Mean serum hepcidin levels were 116.3 ± 32 ng/ml. On univariate analysis of factors influencing mortality, age, sex, and presence of comorbidities did not show significant association, but the levels of serum bicarbonate, albumin, creatinine, cholesterol, triglycerides, and the high-sensitivity C-reactive protein, hepcidin, showed a significant association with mortality. Serum hepcidin level of 120 ng/ml predicted mortality with a sensitivity of 100% and specificity of 85%. Conclusions Serum hepcidin is associated with all-cause mortality and cardiovascular mortality in patients on hemodialysis. Hepcidin levels may serve a good predictor of cardiovascular outcomes in patients on hemodialysis.

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Alport Syndrome (AS) is an inherited glomerular disease, which invariably progresses to End Stage Kidney Disease (ESRD). It can be associated with hearing impairment and ocular defects. The disease can be X-linked caused by mutations in the Type 4 Collagen alpha 5 chain (COL4A5), Autosomal Recessive (ARAS) or Autosomal Dominant (ADAS) caused by mutations in the Type 4 Collagen alpha 3 chain (COL4A3) or alpha 4 chain (COL4A4). We report a novel mutation in COL4A5 Gene causing XLAS resulting in Chronic Kidney Disease in a 34-year-old male. Whole genome sequencing of the patient, showed hemizygous variant (c.1690G>C, p. Gly564Arg) in the COL4A5 gene. The same variant was detected in his mother and his only daughter establishing that the mutation is pathogenic.

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Background Several research studies aimed to explain the high mortality among hemodialysis (HD) patients. Our study aimed to describe the mortality in our Governorate (Dakahlia) and to explore its potential risk factors. Patients and methods This prospective (follow-up) study was conducted in four HD units on 120 patients who were followed up over the 12-month period (September 2018–August 2019). At enrollment and every 3 months, all patients were subjected to history taking, physical examination, and laboratory tests for the 12-month period or until the patient died. Results The 120 HD cases were 72 (60%) male patients, and 48 (40%) female patients with a median age of 46.5 years. Over 1-year follow-up, 26 (21.7%) patients died. Survival analysis with the Log-rank test shows no statistically significant difference in survival times based on examined variables (sex, diabetes, hypertension, current smoking, and Subjective Global Assessment). The results of the Cox proportional hazards model [to assess sex, age, diabetes, hypertension, current smoking, HD duration (years), and Subjective Global Assessment as predictors of 1-year mortality in HD patients] show that out of these seven predictor variables, only diabetes was a statistically significant independent predictor. Conclusion HD-related mortality is high in Dakahlia Governorate (21.7%). Diabetes mellitus is an independent risk factor for mortality with a hazard ratio of 2.97.

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