Background Preserving functional vascular access is crucial for patients with end-stage renal disease undergoing hemodialysis, as its failure can lead to severe life-threatening consequences. Complications related to vascular access are a significant cause of hospital admissions. Recognizing predictive factors and therapeutic targets may help in designing effective preventive strategies. This study aims to investigate the association between vascular access complications and markers of mineral metabolism disturbances. Patients and methods This single-center prospective cohort study (2022–2024) included 100 adults with end-stage renal disease on regular hemodialysis referred for arteriovenous fistula (AVF) creation. A predialysis blood sample was collected for kidney function tests, electrolytes, mineral-metabolism markers [25-hydroxyvitamin D, intact parathyroid hormone, fibroblast growth factor 23 (FGF23)], lipid profile, and routine hematologic and inflammatory parameters. Postoperatively, patients were followed up to evaluate maturation and detect early complications, and classified into successful or failed AVF outcomes based on clinical assessment and Doppler ultrasonography. Results Among the studied patients, 45 achieved successful AVF maturation, whereas 55 experienced failure. Those with failed AVFs had significantly higher BMI ( P <0.001), magnesium ( P =0.009), intact parathyroid hormone ( P =0.007), and FGF23 levels ( P <0.001), with markedly lower vitamin D levels ( P <0.001). Correlation analysis demonstrated a strong negative association between FGF23 and AVF success ( r =–0.624, P <0.001), and a strong positive association between vitamin D and AVF success ( r =0.576, P <0.001). Multivariate regression analysis identified FGF23 (odds ratio=0.002, P =0.002) and vitamin D (odds ratio=1.186, P =0.001) as independent predictors of AVF outcomes. Conclusion High FGF23 and low vitamin D levels are key independent predictors of AVF failure in patients undergoing hemodialysis.
Background Coronary artery calcification (CAC) is highly prevalent in patients with chronic kidney disease (CKD) and is strongly associated with adverse cardiovascular outcomes. Pentoxifylline (PTX), a methylxanthine derivative with anti-inflammatory and hemorheologic properties, may have a potential role in attenuating vascular calcification and slowing CKD progression. Patients and methods This prospective, open-label, randomized controlled trial included 80 CKD patients were randomized to receive either PTX 400 mg twice daily plus conventional therapy ( n =40) or conventional therapy alone ( n =40) for 6 months. Baseline and follow-up assessments included clinical evaluation, laboratory investigations, and coronary artery calcium scoring using multislice computed tomography with the Agatston method. The primary outcome was progression of CAC, while secondary outcomes included CKD progression and changes in renal and biochemical parameters. Results Baseline demographic, clinical, and laboratory characteristics were comparable. After 6 months, estimated glomerular filtration rate declined significantly in the control group but remained stable in the PTX group. CKD progression was less frequent in PTX group (12.5 vs. 32.5%, P =0.032). The Agatston score increased significantly in the control group but decreased in the PTX group, with a significantly lower score observed in the intervention arm ( P =0.036). Regression of coronary calcification occurred more frequently with PTX (27.5 vs. 5%, P =0.023). Multivariate analysis identified group allocation as the sole independent predictor of CAC progression. Conclusion PTX therapy significantly attenuated CAC progression and was associated with reduced CKD progression in patients with moderate to advanced CKD.
Background Hypertension is common in chronic kidney disease (CKD), and white coat hypertension (WCH) complicates its diagnosis and treatment. Patients and methods We conducted a cross-sectional study of 66 CKD patients with uncontrolled clinic blood pressure (BP) at the nephrology outpatient clinic at Suez Canal University Hospital, comparing home and clinic BP readings to detect WCH. Results The mean clinic systolic BP (167.2 ± 13.7 mmHg) was significantly higher than the mean home systolic BP (131 ± 12.5 mmHg) ( P <0.005). WCH was identified in 65.2% of patients and was significantly associated with diabetes (odds ratio: 4.92; 95% confidence interval: 1.34–18.15). Conclusions WCH is highly prevalent, affecting nearly two-thirds of CKD patients with elevated clinic BP, highlighting the need for routine home BP monitoring for accurate diagnosis and individualized management.
Background Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis, but its maturation and long-term function are often suboptimal. Preoperative handgrip exercise (HGE) may improve vascular remodeling and enhance outcomes of AVF. This study aimed to evaluate the effect of preoperative handgrip training on vein diameter (VD) and AVF functional performance in patients with chronic kidney disease (CKD). Patients and methods This was a single-center, prospective pilot study including 40 patients with advanced CKD eligible for AVF creation. Candidates were allocated into an exercise group ( n =20), who performed daily HGEs for 8 weeks prior to surgery, and a control group ( n =20), who received standard care without exercise. VDs at the cubital and wrist levels were measured by Doppler ultrasound at baseline, after 8 weeks, and 6 weeks post-AVF creation. AVF maturation and functional performance were assessed by postoperative blood flow and site distribution. Subgroup analysis was performed in patients with diabetes. Results Baseline demographic and clinical characteristics were comparable between groups. After 8 weeks, the exercise group showed significantly greater increases in VD at both the cubital and wrist sites compared with the control group. Postoperatively, the exercise group maintained larger venous diameters (cubital: 6.96 ± 0.17 vs. 6.00 ± 0.13 mm, P <0.00001; wrist: 7.10 ± 0.46 vs. 6.00 ± 0.07 mm, P <0.0001). AVF blood flow (Qa) was higher in the exercise group (915 ± 117 vs. 635 ± 37 ml/min, P <0.0001), and distal fistulas were more common (75 vs. 20%, P =0.03). Among diabetic patients, exercise was associated with significantly larger postoperative VDs and higher blood flow compared with the control group. Conclusions Preoperative HGE is a simple, low-cost intervention that enhances venous dilatation, improves AVF blood flow, and favors distal AVF creation in patients with CKD. These findings support the incorporation of structured exercise into preoperative care to optimize vascular access outcomes. Larger, multicenter studies are warranted to confirm these results.
Background Pregnancy induces substantial renal physiological changes, including glomerular hyperfiltration and decreased serum creatinine concentrations. Creatinine-based estimation equations developed for nonpregnant populations may inaccurately reflect pregnancy-related hyperfiltration. This study evaluated the accuracy of Cockcroft–Gault-derived estimated glomerular filtration rate (eGFR) against measured creatinine clearance (CrCl) across pregnancy trimesters in women with normal kidney function. Patients and methods This cross-sectional study was conducted at Mansoura University Hospital and Ministry of Health hospitals in Egypt between May and October 2024. A total of 30 pregnant women (10 per trimester) with singleton pregnancies and no comorbidities were enrolled. Twenty-four-hour CrCl was compared with Cockcroft–Gault-derived eGFR. Statistical analyses included Paired t -tests, Wilcoxon signed-rank tests, and Bland–Altman analysis. Results The mean maternal age was 28.7 ± 6.41 years, with a mean BMI of 32.7 ± 5.07 kg/m 2 . Mean measured CrCl was 121 ± 12.6 ml/min, whereas mean eGFR was substantially higher at 212 ± 49.1 ml/min/1.73 m 2 . Significant overestimation was observed across all trimesters: first-trimester bias 73.8 ± 60.21 ml/min ( P =0.004), second-trimester bias 98.8 ± 58 ml/min ( P <0.001), and third-trimester bias 99.45 ± 43.1 ml/min ( P <0.001). Bland–Altman analysis demonstrated poor agreement with wide limits and proportional bias, particularly at higher GFR values. Conclusion The Cockcroft–Gault equation systematically overestimates GFR throughout pregnancy, with the magnitude of overestimation increasing from early to late gestation. Clinicians should exercise caution when using this equation in pregnant women. Twenty-four-hour CrCl measurement remains preferable for accurate assessment of renal function during pregnancy, particularly for medication dosing adjustments.
Background Acute kidney injury (AKI) is a major health problem with poor short- and long-term outcomes. Community-acquired AKI (CA-AKI) occurs if the patient developed an increase in serum creatinine at the time of admission and that increase has developed outside the hospital. Infections, such as gastroenteritis, pneumonia, skin and soft tissue infections, acute glomerular diseases, obstetric complications, and herbal remedies are common etiologies. Patients and methods This is a single-center prospective observational study where we evaluated the clinical characteristics, risk factors, associated comorbidities, and outcomes of CA-AKI in patients admitted to a Hospital over a 12-week period. Results We identified 212 patients with CA-AKI, which represented 1.86% of patients admitted to a hospital during the study period, of which 121 (57.1%) were female, with a mean age of 59.69 ± 14.49 years. Hypertension, diabetes, and chronic kidney disease were the most common associated comorbidities. Renal causes were the most common cause of AKI in 146 patients, prerenal in 93 patients and postrenal in 50 patients. The primary outcome was in-hospital mortality, which occurred in a third (33%) of the afflicted patients, while renal recovery occurred in the majority of CA-AKI cases with variable rates of partial and complete recovery. Follow-up of renal functions after 3 months of discharge revealed stable serum creatinine in 66 (50%) patients, 23 (17.4%) patients showed further improvement in serum creatinine (lower serum creatinine than its value upon discharge) and nine (6.8%) patients deteriorated further. Conclusions Hypertension, diabetes, and chronic kidney disease were the most common associated comorbidities with CA-AKI. Sepsis-associated AKI and hypovolemia were the most common etiologies. While most CA-AKI episodes resulted in renal recovery, around one-third of the affected patients died.
Background Secondary hyperparathyroidism and cardiovascular complications are common in hemodialysis patients. Genetic variations in the calcium-sensing receptor (CaSR) gene may influence parathyroid hormone regulation and cardiovascular outcomes in this population. This study aimed to investigate the association between the CaSR rs1042636 polymorphism and echocardiographic findings among hemodialysis patients with hyperparathyroidism. Patients and methods This observational study included 25 adult hemodialysis patients receiving cinacalcet therapy at Mansoura Urology and Nephrology Center between November 2024 and November 2025. Patients were genotyped for CaSR rs1042636 polymorphism using TaqMan real-time PCR and divided into AG ( n =18) and GG ( n =7) groups. Demographic, clinical, dialysis-related, and laboratory data – including calcium, phosphate, intact parathyroid hormone (iPTH), and hematological parameters – were collected. Dialysis adequacy was assessed via single-pool Kt/V. Transthoracic echocardiography was performed to evaluate cardiac structure, systolic and diastolic function, valvular abnormalities, and left ventricular mass. Statistical comparisons between groups were performed using χ 2 or Student’s t test, with P value less than 0.05 considered significant. Results Baseline demographics, BMI, dialysis vintage, vascular access, and comorbidities were comparable between groups. No significant differences were observed in hematological parameters, calcium, phosphate, or cardiovascular events. GG patients had significantly lower iPTH compared with AG patients ( P =0.038). Echocardiographic evaluation revealed higher frequencies of valvular calcification, mitral regurgitation, and aortic regurgitation among AG patients. In contrast, tricuspid regurgitation, left ventricular hypertrophy, chamber dimensions, and ejection fraction were similar between groups. Conclusion The CaSR gene rs1042636 polymorphism is associated with differences in iPTH levels and valvular abnormalities among hemodialysis patients, suggesting a potential role of this genetic variant in modulating mineral metabolism and cardiovascular risk in this population.
Background Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disorder, accounting for 5–10% of end-stage kidney disease cases worldwide. It is a monogenic, multisystem disorder characterized by progressive bilateral renal cysts and frequent extrarenal involvement. The aim of this study is to evaluate the demographic and familial profiles, clinical presentations, imaging characteristics, and biochemical abnormalities of patients with ADPKD. Patients and methods This ambispective observational cohort study was conducted at a tertiary care center in North India from August 2022 to 2024. Fifty adult patients diagnosed with ADPKD based on Ravine ultrasonographic criteria and with an estimated glomerular filtration rate (eGFR) greater than 15 ml/min/1.73 m 2 were enrolled. eGFR was calculated using the CKD-EPI 2021 creatinine-based equation. Demographic, clinical, imaging, and laboratory data were collected and analyzed using SPSS version 25.0. Results The mean age was 48.0 ± 12.0 years, and 54% were females. A positive family history was present in 76%, including 44% of index cases. Common presenting symptoms included flank pain (64%) and abdominal fullness (24%). Renal dysfunction, hypertension, and proteinuria were observed in 60, 52, and 48% of participants, respectively. Hepatic cysts were the most frequent extrarenal manifestation (28%). The mean total kidney volume by ultrasound was 314.4 ± 138.2 ml. Older age, hypertension, and proteinuria were significantly associated with lower eGFR ( P <0.05). Conclusion This study provides one of the few detailed Indian datasets describing the clinical, biochemical, and imaging spectrum of ADPKD. Older age, hypertension, and proteinuria emerged as key predictors of renal function decline. In resource-limited settings, these simple clinical parameters can guide risk stratification and management. Larger multicenter studies incorporating genetic testing and MRI-based volumetry are needed for further validation.
Background Lupus nephritis (LN) is a critical complication of systemic lupus erythematosus (SLE) that significantly impacts renal outcome. The aim of this study is to investigate the relationship between the timing of LN onset in SLE patients and long-term renal outcome. Patients and methods This retrospective cohort study included 300 patients with biopsy-proven LN divided into two groups: early-onset LN ( n =225), in which LN occurred within 5 years of SLE diagnosis, and late-onset LN ( n =75), in which LN occurred beyond 5 years of SLE diagnosis. Results Early-onset LN patients more frequently received pulse steroids and cyclophosphamide induction therapy ( P =0.003; P =0.024). After 1 year of diagnosis of LN, early-onset LN had a greater risk of Acute kidney injury episodes ( P =0.017). After 5 years of follow-up, more late-onset LN patients developed chronic kidney disease or required haemodialysis ( P =0.04). Multivariate analysis identified late-onset LN (OR=3.5, 95% CI 1.2–10.6, P =0.02), baseline serum creatinine (Ser Cr) (OR=1.6, 95% CI 1.12–2.3, P =0.009), and higher chronicity index (OR=1.34, 95% CI 1.13–1.6, P <0.001) as independent predictors of poor renal outcome. Conclusions While Acute kidney injury occurs more frequently in early-onset LN patients, late-onset LN is associated with greater chronic renal damage and poorer long-term renal outcomes. Baseline renal function and chronicity index are key prognostic indicators in LN patients.
Background Acute kidney injury (AKI) is frequently associated with mineral and endocrine disturbances, yet limited data exist regarding the prevalence and impact of these abnormalities in critically ill patients. This study aimed to evaluate the relationship between AKI and mineral bone disease parameters, including serum calcium, vitamin D, phosphorus, and parathyroid hormone. Patients and methods A prospective study was conducted at Assiut University Hospitals between November 2021 and November 2023. A total of 400 patients with AKI were enrolled and stratified into stages I ( n =200), II ( n =150), and III ( n =50) according to KDIGO criteria. Clinical, biochemical, and outcome data were collected. Results A total of 400 patients with AKI were included: stage I (50%), stage II (37.5%), and stage III (12.5%). Baseline characteristics were comparable across groups. Renal function markers significantly worsened with advancing AKI stage ( P <0.001). Serum calcium and vitamin D levels were significantly lower in stage III, with higher rates of hypocalcemia (18%) and vitamin D deficiency (24%) ( P <0.001). Phosphorus and parathyroid hormone showed no significant differences. Mortality increased significantly with AKI severity (5, 8, and 22% for stages I–III; P =0.01), alongside longer hospital stay. Nonsurvivors had significantly lower vitamin D and higher deficiency rates ( P <0.001). Conclusion Vitamin D deficiency and hypocalcemia are common in critically ill patients with AKI, especially in advanced stages. These abnormalities may influence patient outcomes, particularly survival. Multicenter trials and long-term follow-up studies are needed to investigate further the prognostic value and therapeutic potential of correcting mineral disorders in AKI.
Maintenance hemodialysis (HD) patients are at higher risk for atherosclerosis and cardiac valve calcification (CVC). Red cell distribution width (RDW) was found to be an independent predictor of cardiovascular deaths. This study aims to investigate the association between RDW and cardiovascular disease risk factors, as well as its utility as a marker for CVC and atherosclerosis in HD patients. A cross-sectional observational study in which demographic, anthropometric, and clinical data of 100 adult patients on HD were reported. Laboratory data included complete blood count parameters, as mean corpuscular volume, RDW-coefficient of variation (CV), and neutrophil/lymphocyte ratio, serum albumin, calculation of Kt/V, serum phosphorus, serum calcium, calcium×phosphorus product, intact parathyroid hormone, serum ferritin, C-reactive protein (CRP), and lipid profile. Echocardiography was performed to detect CVC and average common carotid intima-media thickness (CIMT) by B-mode ultrasonography. CVC has a positive correlation with age, HD duration, RDW-CV, CRP, and calcium×phosphorus product. While abnormal increased CIMT has a positive correlation with HD duration, RDW-CV, CRP, and aortic valve calcification, it has a negative correlation with high-density lipoprotein. RDW-CV had a significant positive correlation with HD duration and aortic valve calcification, but a significant negative correlation with high-density lipoprotein. CVC was associated with age, HD duration, RDW-CV, CRP, and Ca×Ph product in simple regression. Moreover, HD duration, RDW-CV, and CRP were good predictors for abnormal increased CIMT in multiple regression analysis. RDW-CV is associated with CVC and abnormal increased CIMT and is a good predictor for abnormal increased CIMT in HD patients.
Background Even though extensive investigation has been done to understand better the pathophysiology, early detection, and clinical management of sepsis, the death rate for sepsis cases in ICUs is still alarmingly high. This study aimed to assess the neutrophil-to-lymphocyte-and-platelet ratio (N/LP ratio) as a predictor of death in septic acute kidney injury (AKI) cases. Patients and methods A total of 150 patients with septic AKI have been recruited in the present study. Out of those cases, 50/150 (33.3%) patients died, and 100/150 (66.7%) patients improved. All cases underwent a comprehensive history and clinical assessment. Routine blood tests and blood cultures were done in all patients with calculation of the N/LP ratio. Results The survivor group had a significantly lower mean age (51.23 ± 8.56 vs. 60.75 ± 9.60 years; P <0.001) and a lower frequency of mechanical ventilation (7 vs. 22%; P =0.01). A significantly reduced serum albumin (3.10 ± 0.22 vs. 3.98 ± 0.20 g/dl; P <0.001) and higher baseline N/LP ratio (12.87 ± 1.09 vs. 6.78 ± 2.10; P <0.001) and follow-up N/LP (5.15 ± 1.34 vs. 15.67 ± 2.89; P <0.001) among the nonsurvivor group. The N/LP ratio showed a significant positive correlation with Acute Physiology and Chronic Health Examination-II ( r =0.56), Sequential Organ Failure Assessment ( r =0.69), and length of stay ( r =0.23). Predictors of death in cases that had septic acute kidney damage were mechanical ventilation [odds ratio (OR)=2.45], N/LP ratio (OR=3.56), low serum albumin (OR=1.33), Acute Physiology and Chronic Health Examination-II (OR=2.34), and Sequential Organ Failure Assessment (OR=2.79). Using receiver operating characteristic curve analysis, at a cutoff point more than 10.19, it was found that the N/LP ratio had 91.2% overall accuracy in the prediction of death in cases that had septic AKI. Conclusion Elevated N/LP level could be a predictor for the development of AKI among septic patients at the ICU admission. It was also independently related to in-hospital death in septic-AKI cases. Large multicenter studies are recommended.
Background Systemic lupus erythematosus (SLE) affects multiple organs, presenting variability in initial symptoms and organ involvement. Lupus nephritis (LN) is a critical manifestation of SLE, linked to considerable morbidity and mortality concerns. This study sought to determine the significance of uric acid as a predictive and prognostic indicator in the advancement of LN. Patients and methods A total of 100 female cases diagnosed with SLE in accordance with the 2019 Classification developed by the European League Against Rheumatism and the American College of Rheumatology. Two groups were established according to renal affection criteria for SLE: the LN group and the No-LN group. All patients underwent complete medical histories and physical examinations. A full blood count, liver function tests, urine analysis, kidney function tests, 24 h urinary protein, complement 3 and complement 4 tests, serum uric acid (SUA), and other baseline laboratory data were all performed. Results Baseline data of the studied groups revealed that patients with LN had significantly higher disease’s activity. cases with LN had significantly higher SUA. SUA had positive significant correlation with disease’s activity, creatinine, urea, proteinuria with negative correlation with complement 3, complement 4, and glomerular filtration rate. Predictors of LN among those with SLE were; younger age, high disease’s activity, low complement 3 and raised uric acid. SUA at cutoff point greater than 6.78 mg/dl had 88% overall accuracy in prediction of LN in cases with SLE. Conclusion Individuals with SLE are at an increased risk of developing LN in the presence of SUA. LN and disease activity were independently related to SUA levels. Further research is necessary to validate these results.
Background Malnutrition remains a prevalent and critical concern among patients undergoing maintenance hemodialysis (HD), with no single parameter reliably predicting its adverse outcomes. This study aimed to evaluate the prevalence of protein-energy wasting (PEW) and its impact on dialysis-related morbidities and 1-year mortality. Patients and methods A total of 104 prevalent HD patients were followed over 1 year. Comprehensive clinical and laboratory evaluations were conducted, including assessments of inflammatory markers. Nutritional status was assessed using a combination of biochemical indices, anthropometry, bioelectrical impedance analysis, and standardized nutritional scoring systems. Patients were monitored for hospitalization, dialysis-related complications, and all-cause mortality. Results According to the International Society of Renal Nutrition and Metabolism (ISRNM) criteria, PEW was identified in 22.1% of the cohort. Patients with PEW exhibited significantly lower serum phosphorus, creatinine, hemoglobin, total protein, cholesterol, albumin, prealbumin, and dialysis adequacy compared with non-PEW counterparts. Conversely, higher levels of ferritin, high-sensitivity C-reactive protein, dialysis-related complications, hospitalization, and mortality were observed in the PEW group. PEW was more prevalent among patients with permanent dialysis catheters. Among deceased patients, lower values of albumin, prealbumin, Kt/V, bone mass, mid-arm, and waist circumferences along with elevated high-sensitivity C-reactive proteinwere noted. Multivariate logistic regression identified the ISRNM score as an independent predictor of mortality. Conclusion Protein-energy wasting significantly increases the risk of morbidity and mortality in HD patients. The ISRNM score offers a valuable tool for identifying high-risk individuals and predicting mortality.
Background Alterations in portal vein flow (PVF) are emerging as potential markers of venous congestion in congestive heart failure (HF); however, their dynamic changes during decongestion, and their utility in assessing HF status remain unclear. The aim of this study was to evaluate PVF parameter changes in HF patients during congestion and post-decongestive therapy, and their association with HF compensation and renal function. Patients and methods This cross-sectional study enrolled 35 HF patients (12 compensated, 23 noncompensated) at Assiut University Hospital’s ICU. Baseline and postdecongestion assessments included clinical evaluation, laboratory tests (e.g., eGFR, creatinine), point-of-care ultrasound (inferior vena cava size, PVF via Doppler), and echocardiography. PVF parameters (V.max, V.min, PI) were compared between groups and GFR categories, with diagnostic accuracy assessed through receiver-operating characteristic curves and predictors identified by logistic regression. Statistical significance was set at P less than 0.05. Results Mean age was 57 ± 12 years; 65.7% had noncompensated HF. At congestion, noncompensated HF showed lower V.max (15.13 ± 2.59 vs. 20.33 ± 3.34 cm/s), V.min (8.84 ± 1.64 vs. 9.47 ± 1.76 cm/s), and PI (0.41 ± 0.06 vs. 0.53 ± 0.06) than compensated HF ( P <0.001). PI decreased postdecongestion (0.5 ± 0.1 to 0.4 ± 0.1). V.max [area under the curve (AUC)=0.630, specificity=100%] and V.min (AUC=0.605, specificity=91.67%) had moderate diagnostic accuracy for noncompensated HF, unlike PI (AUC=0.527). PVF varied significantly with GFR ( P <0.001), with higher V.max and V.min in mild to dodtoatmoderate vs. severe GFR decline. Inferior vena cava size (OR=1.688, P =0.023) and right heart dilatation (OR=16.219, P =0.043) predicted noncompensated HF. Renal impairment was evident (eGFR 21.7 ± 8.4 ml/min/1.73 m²). Conclusion PVF parameters indicate venous congestion and renal function in HF, which change with decongestion, but are moderately diagnostically useful. POCUS-derived PVF assessment can potentially aid in the monitoring of HF, especially in the context of cardiorenal syndrome, but needs validation.
In adults with nondialysis chronic kidney disease (CKD), dietary management plays a central role in conservative treatment. Dietary interventions, particularly protein restriction, play pivotal roles in mitigating intraglomerular hypertension, slowing disease progression, alleviating uremic symptoms, and postponing the initiation of kidney replacement therapy. According to the KDIGO 2024 and KDOQI 2020 guidelines, protein intake in CKD should be tailored to disease stage, with strategies spanning from standard low-protein diets to very-low-protein diets supplemented by essential amino acids or ketoacid analogs. Plant-based nutrition has emerged as a promising strategy, offering renoprotective and cardiometabolic benefits, although concerns remain regarding hyperkalemia, nutritional adequacy, and long-term adherence. This article summarizes the evidence for protein restriction, supplementation strategies, and the impact of plant-centered nutrition, emphasizing the importance of individualized, patient-centered nutrition therapy under professional supervision to optimize outcomes and minimize risks in CKD care.
Background Sarcopenia is prevalent among hemodialysis patients and is linked with decreased physical function, diminished quality of life, and a total increase of cardiovascular risk. Patients and methods A cross-sectional study was conducted at Menoufia University Hospitals, including 86 end-stage renal disease patients, who were classified into three groups according to the European Working Group on Sarcopenia in Older People 2 criteria based on sarcopenia severity. Medical history, anthropometric measurements, nutritional condition, physical function tests, and laboratory investigations were included to analyze differences between groups, considering influential factors. Results Sarcopenia’s bioimpedance parameters including appendicular skeletal muscle index (16.21 ± 2.40), appendicular skeletal muscle index (5.02 ± 1.19), phase angle (°) (5.7 ± 0.5) hand strength (20.81 ± 5.15), were significantly lower than the nonsarcopenic group with low physical activity assessed by International Physical Activity. The multivariate analysis and the receiving operation characters curve revealed that malnutrition was the most predicted risk factor for sarcopenia in regular hemodialysis patients (odds ratio=3.54; confidence interval: 1.911–5.814, P =0.000) with cut off value less than 3.5 with high sensitivity and specificity followed by diabetes mellitus (odds ratio=1.619; confidence interval: 0.312–0.852, P =0.01) and other predictors. Conclusion Malnutrition, physical inactivity, and associated comorbidity may be significant modifiable factors in the sarcopenia development and progression in hemodialysis cases. These results emphasize the value of early screening and individualized intervention strategies for managing sarcopenia in affected patients.
The vascular endothelial growth factor (VEGF) is a subfamily of growth factors that play an essential role in vasculogenesis and angiogenesis. VEGFs stimulate the creation of new blood vessels during embryonic development and collaterals to bypass blood vessel obstruction and/or vascular injury. Anti-VEGF agents were approved as a new promising management for solid tumors and their metastasis, as well as retinal vascular disorders. Their use was associated with significant nephrotoxic effects. Hypertension, proteinuria, microscopic angiopathy, electrolyte imbalance, and chronic kidney disease were reported as common and serious VEGF inhibitors complications, which may affect the management plan. In this review, we tried as much as possible to summarize what has been discussed in the literature about the nephrotoxic effects of anti-VEGF agents.
Background Erectile dysfunction represents a prevalent yet unrecognized complication in male hemodialysis (HD) patients. Hormonal disturbances, mineral metabolism abnormalities, and psychological stress are potential contributors. The objective of this study was to assess erectile function (EF) in HD patients and examine its association with testosterone levels, biochemical markers, and psychological status. Patients and methods This case–control study enrolled 80 male HD patients and 40 healthy controls matched for age and BMI. Individuals with diabetes or chronic systemic illness were excluded. EF was evaluated using the International Index of Erectile Function (IIEF)-5 questionnaire. Serum testosterone, ionized calcium, phosphorus, intact parathyroid hormone (iPTH), hemoglobin, and dialysis adequacy (Kt/V) were measured. The Hospital Anxiety and Depression Scale was deployed to ascertain anxiety and depression. Moreover, we carried out correlation and multivariate regression analyses. Results HD patients had significantly lower IIEF-5 scores (12.5 ± 4.3 vs. 21.6 ± 3.9, P <0.001) and testosterone levels, along with higher phosphorus and iPTH levels. EF (IIEF-5 score) showed negative correlations with depression ( r =–0.61), anxiety ( r =–0.54), and a positive relation with testosterone ( r =0.62). In multivariate analysis, significant predictors of IIEF-5 score were testosterone (β=0.032, P <0.001), depression (β=–0.41, P <0.001), anxiety (β=–0.28, P =0.001), iPTH (β=–0.008, P =0.006), and age (β=–0.12, P =0.003). Conclusion Erectile dysfunction is prevalent among HD patients and is independently linked to low testosterone, psychological distress, and mineral metabolism disturbances. Therefore, early diagnosis and multidisciplinary management are recommended.
