Learning Sciences for Higher Education

Gawad M.A., Hosny M., Ayoub M., Elnahrawy R.S., Soultan M., Yasser M., Mahdy E.

Background Chronic kidney disease (CKD) significantly impairs the quality of life (QoL) of patients, with hemodialysis (HD) being the predominant kidney replacement therapy (KRT) worldwide. HD patients frequently suffer from various complications, including psychological disorders such as depression, anxiety, and sleep disturbances, which profoundly affect their quality of life. This study aimed to investigate the prevalence of depression, anxiety, and low quality of sleep among Egyptian hemodialysis patients. Patients and methods A cross-sectional study was conducted at Abu-Qir Specialty Hospital, Alexandria, Egypt, involving 61 HD patients. Data were collected through individual interviews using validated Arabic versions of the Patient Health Questionnaire depression scale (PHQ-9), Generalized Anxiety Disorder (GAD-7) score, and Pittsburgh Sleep Quality Index (PSQI). Demographic, clinical, and laboratory data were also obtained. Results The prevalence of depression, anxiety, and sleep disturbances among HD patients was found to be 67.21%, 50.82%, and 100%, respectively. Multivariate regression analysis revealed that poor sleep quality (P=0.01) and anxiety (P<0.01) were significantly associated with depression. Anxiety was significantly associated with depression (P<0.01) and hemoglobin level (P=0.03). Poor sleep quality was predominantly influenced by depression (P=0.02). Conclusion The study highlights the high prevalence of psychological disorders and sleep disturbances among HD patients in Egypt, emphasizing the need for integrated care models. Routine screening and comprehensive management of these conditions are essential to improve quality of life and clinical outcomes. Further research is needed to explore underlying mechanisms and develop effective interventions tailored to HD patients’ unique challenges.

Mostafa M.H., Tony E.A., Ashmawy A.M., Mahmoud A.A., Othman M.A., Kamel Y.M.

Background Nonalcoholic fatty liver disease (NAFLD) and chronic kidney disease (CKD) share mechanistic pathways related to metabolic dysfunction. The aim of this study was assessing prevalence of nonalcoholic liver disease among patients with CKD. in addition to, determine the relationship between the severity of fatty liver in nonalcoholic liver disease assessed by liver enzymes and tissue inhibitor of metalloproteinase-1 (TIMP-1). Patients and methods The current study enrolled a total of 80 patients with different stages of CKD. It was conducted in the period between March 2020 and March 2021. All patients were subjected to thorough medical history, clinical examination, baseline laboratory data, ultrasound, fibroscan, and also, the level of TIMP-1 was assessed. Results A total of 15 (18.8%) patients with CKD had NAFLD while the other 65 (81.2%) patients did not have NAFLD. Patients with NAFLD had significantly higher BMI and TIMP-1. There was a positive correlation between the grade of NAFLD as detected by fibroscan and the stage of CKD. Also, the NAFLD group had a significant difference as regard liver stiffness where the majority (84.6%) of patients without NAFLD had f0 and the majority (73.3%) of those with NAFLD had f1. Predictors for the development of NAFLD among patients with CKD were; TIMP-1, estimated glomerular filtration rate, and degree of fibrosis. TIMP-I at cutoff point greater than 21, has 97.2% accuracy for prediction of NAFLD in patients with CKD while f1 degree of fibroscan has 89.7% accuracy for prediction of NAFLD in patients with CKD. Conclusion Patients with CKD are vulnerable to develop NAFLD. Early detection of those patients may help in improving their outcomes. Also, TIMP-1 is considered as a novel biomarker for early diagnosis of NAFLD in patients with CKD. fibroscan is considered an available, cheap, and noninvasive method for assessment of NAFLD severity.

Abdulaziz H.M., Saleh M.A., Hatata A.E., Abdelaziz H.M.

Background In the general population, prior research has demonstrated the positive effects of fasting on the heart, where it is linked to a reduction in the risk factors for cardiovascular disease. Although hemodialysis (HD) patients are considered very high risk, some patients are highly motivated and insist on fasting. Limited data exists on the effect of Ramadan fasting on heart rate variability (HRV) a measure of cardiac autonomic function among maintenance HD patients. Patients and methods An observational longitudinal study of Ramadan fasting patients on maintenance HD. All participants underwent a 5 min Holter ECG recording at the end of the HD session during Ramadan 29 and 30, then another 5 min Holter ECG recording two months after Ramadan. Time and frequency domain HRV indices were analyzed. Results Among 95 HD patients assessed for eligibility, 53 practiced Ramadan fasting either daily or intermittently. Forty-seven patients met inclusion and exclusion criteria and underwent 5 min Holter ECG recordings twice. The mean age of participants was 47.77 years (±13.78) and 59.6% were males. Patients did not differ significantly about heart rate, frequency, and time domain measures (P>0.05) during and two months after Ramadan. Conclusion Practicing Ramadan intermittent fasting does not impose a substantial risk to the cardiac autonomic nervous system function among maintenance HD patients, further research is required to confirm these findings.

Zaki S.A., Labib A.W., Hussien A.K., Elwany M.N., Elghoneimy H.A.

Background Chronic kidney disease and end-stage renal disease (ESRD) are worldwide public health problems with increasing incidence and prevalence. Cardiovascular disease is the most common cause of morbidity and mortality among patients with ESRD. Hepatitis C virus (HCV) is a worldwide health problem. The prevalence of HCV infection among hemodialysis (HD) patients is generally much higher than that among the general population. This study aimed to compare serum levels of N-terminal probrain natriuretic peptide (NT-ProBNP) and its relation to diastolic dysfunction and Child–Pugh in HCV-positive and HCV-negative patients on HD. Patients and methods This cross-sectional study included 60 ESRD patients; group A, 30 HCV-positive patients on HD, and group B, 30 HCV-negative patients on HD. Routine laboratory investigations, serum NT-ProBNP, and echocardiography were done for all patients. Results HCV-positive patients had a substantially higher median serum level of NT-ProBNP (3424.5 vs. 2807 pg/ml; P=0.031, respectively) than HCV-negative patients. The level of NT-ProBNP and diastolic dysfunction showed a strong positive correlation (P<0.001). The level of NT-ProBNP and the HCV RNA PCR level showed a significant positive correlation (P<0.001), and the level of NT-ProBNP increased significantly as the Child–Pugh score increased (P<0.001). Conclusion Compared to HCV-negative patients, HCV-positive dialysis patients exhibited more diastolic dysfunction and higher levels of NT-ProBNP. Additionally, HCV patients with Child–Pugh C had higher levels of NT-ProBNP than Child B and A patients, respectively.

Gad D.E., Saleh M., Sally S., Sayed-Ahmed N.

Background Cardiovascular disease is the primary cause of morbidity and mortality in chronic kidney disease (CKD) patients, with vascular calcifications being a key predictor. Elevated serum uric acid (UA) has been implicated in vascular health, but its link with coronary artery calcification (CAC) in CKD is underexplored. This study evaluates the association between serum UA levels and CAC in predialysis CKD patients. Patients and methods This cross-sectional study at Mansoura University, Egypt, included 100 predialysis CKD patients aged over 40 years with more than 1 year of disease. Exclusion criteria included significant cardiovascular disease, pregnancy, heavy smoking, or high parathyroid hormone levels. Serum UA and other biomarkers were measured, and CAC was assessed using multislice spiral coronary computed tomography to calculate Agatston scores. Results The median age was significantly higher in the CAC>0 group (62 years) compared to the CAC=0 group (55 years; P=0.017). Serum UA levels showed a borderline significant association with CAC in patients with an estimated glomerular filtration rate (eGFR) less than 30 ml/min/1.73 m2 (odds ratio: 1.26, 95% confidence interval: 1.01–1.61, P=0.051), but no significant association was found in those with moderate kidney impairment (eGFR 30–59 ml/min/1.73 m2). Conclusion Elevated serum UA levels are associated with an increased risk of CAC in CKD patients, particularly in those with severe renal impairment (eGFR<30 ml/min/1.73 m2). This suggests that serum UA may contribute to this population’s pathogenesis of vascular calcification.

Abd Elmohsen W.A., Youssef A.M., Hassan M.S.

Background Obestatin is a proposed anorexigenic gut peptide, known as appetite regulatory hormone. We postulated a potential correlation between obestatin level and malnutrition in hemodialysis (HD) patients. Measurement of obestatin concentration in HD patients would help to evaluate the possible participation of this hormone in protein energy wasting in maintenance HD patients. The objective of this study is to assay the effect of hemodiafiltration (HDF) on serum obestatin level in prevalent HD patients. Patients and methods This cross-sectional study included 40 prevalent HD patients: (20 patients maintained on high-flux HD) and (20 patients maintained on online HDF), 20 healthy individuals served as controls. Full history in detail was taken and a full clinical examination was done, with malnutrition-inflammation score calculation. Routine laboratory analysis was performed also, with evaluation of serum obestatin level pre and post session by enzyme linked immunosorbent assay. Results BMI was statistically significantly lower in HD and HDF groups compared with the control group (P= 0.002). Obestatin level was significantly higher predialysis in HD and HDF groups in comparison to the control group (P value < 0.000), with a higher obestatin reduction ratio post sessions in HDF group than HD group. (P value < 0.001). Obestatin concentration negatively correlated with weight, height, BMI, low-density lipoprotein, and S iron (P value < 0.05), while positively correlated with creatinine, urea, uric acid, and C-reactive protein (P value < 0.05). Regression analysis showed that serum obestatin was independently affected by serum low-density lipoprotein level. Conclusion The current observational data suggests that obestatin hormone was elevated in prevalent HD patients (high-flux HD group and online HDF group) than control group, this hormone might be a marker of inflammation and dyslipidemia. Obestatin removal was better by online HDF than high flux HD.

Habli M.M.

Diabetic nephropathy (DN) is a leading cause of chronic kidney disease and end-stage renal disease globally, affecting 20–50% of diabetic patients. DN is characterized by albuminuria, retinopathy, and progressive reduction in glomerular filtration rate. The pathophysiology involves chronic hyperglycemia, protein glycosylation, mesangial matrix deposition, glomerular hemodynamic alterations, cytokine release, and renin-angiotensin-aldosterone system activation, leading to kidney damage. Differences in DN mechanisms between type 1 and type 2 diabetes are influenced by additional factors such as aging, obesity, and dyslipidemia. Prevention strategies focus on lifestyle modifications and regular screening. Pharmacological management includes tight glycemic control, blood pressure regulation, renin-angiotensin-aldosterone system blockade, and novel agents like sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists. Emerging therapies targeting inflammatory pathways and innovative medications offer promising avenues for future research. Comprehensive management integrating early detection and advanced pharmacological interventions is crucial to mitigating DN progression and improving patient outcomes.

Hamad D.A., Abdelhameid M.A., El Maksoud E.G., Hamid M.A.

Background Cardiac failure is a leading cause of death for patients with chronic kidney disease and end-stage renal disease (ESRD). This study aimed to assess the prevalence of congestive heart failure (HF) in ESRD patients and evaluate its main risk factors. This data will help to provide better care to our patients and improve the outcome. Patients and methods A descriptive observational study was carried out on 290 individuals with ESRD who were on regular hemodialysis. The patients were categorized into two groups based on cardiac failure. The first group consisted of individuals diagnosed with HF, whereas the second group included people who showed no signs of HF. Results Logistic regression analysis revealed that smoking, hemoglobin level, ultrafiltration rate, ischemic heart disease, and ejection fraction were considered independent predictors for HF ESRD patients. Conclusion Congestive HF is prevalent among people undergoing hemodialysis. The main reasons for this high occurrence included the high prevalence of cardiovascular risk factors such as diabetes and hypertension, along with complications of renal failure such as anemia.

Osunbor O.A., Unuigbe E., Adejumo O.A., Okaka E.I.

Background The most common psychological problem encountered in patients with chronic kidney disease (CKD) is depression. However, it is often undiagnosed and undertreated in this group of patients. The prevalence of depression in pre-dialysis CKD patients and its associated factors were determined in this study Patients and methods This was a cross-sectional study that determined the prevalence of depression in pre-dialysis CKD patients using the Hamilton-Depression rating scale. Associated factors with depression were determined by logistic regression. P value less than 0.05 was taken as a significant Results A total of 250 CKD patients with a mean age of 52.3 ± 16.0 years were studied. They comprised of 116 (46.4%) males. Fifty-six (22.4%) of the study participants had depressive symptoms. Depression was significantly more common in those who were unmarried (38.3% vs. 18.7%; P= 0.002) and those whose duration of CKD was less than 6 months (26.6% vs. 15.2%; P= 0.026). Depression was significantly associated CKD stage (P=0.002). The significant factors associated with depression in the CKD patients were being unmarried (adjusted odds ratio: 2.54; confidence interval: 1.19–5.42; P= 0.02) and CKD stage (adjusted odds ratio:3.81; confidence interval: 1.50–9.83; P=0.01). Conclusion Depression is common in the pre-dialysis CKD population and its screening should be included in the evaluation and management of all pre-dialysis CKD patients.

Alhaji A., Murtala U., Mahmood M.I., Audi Y.K., Rabiu T., Baba S.R.

Background Kidney diseases are a heterogeneous group of disorders which if left untreated could lead to chronic kidney disease (CKD) which inadvertently progress to end-stage kidney disease. Renal replacement therapy for end-stage kidney disease is unaffordable, not widely available and require huge financial resources. Knowledge of the prevailing type of kidney disease will help to develop measures of prevention of the disease. This study aims to evaluate the burden and pattern of kidney disease and to determine its outcome over a 2 year period. Patients and methods This is a retrospective study of kidney diseases admission and outcome at Abubakar Tafawa Balewa university teaching hospital over a 2 year period. All case files of patients admitted were retrieved and those with diagnosis of kidney disease were evaluated. Results One thousand and nineteen patients were admitted during the period, 98 of which had kidney disease diagnosis, with 10.4% disease burden. The mean age of the patients was 48.71 ± 12.2 years. CKD accounted for 51% of the total admission, followed by urinary tract infection, acute Kidney injury, Nephrotic syndrome, and Nephritic syndrome each accounting for 19.3, 15.4, 9.2, and 5.1%, respectively. Overall six (10.5%) patients died on admission. Conclusion The burden of kidney disease is high in our study and is mainly due to high prevalence of CKD that affects younger age group.

Sarhan I.I., Abdelgawad M.A., Emara A.A., Elkader M.A., Mohamed A.F.

Background Patients receiving hemodialysis (HD) and kidney transplant recipients are immunocompromised populations prioritized for coronavirus disease 2019 (COVID-19) vaccination, however, there were few clinical trials with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccine responses. Compared with controls, individuals with chronic kidney disease and those on immunosuppressants have lower antibody titers and rates of seroconversion after vaccination. There is a lack of data on their humoral response to COVID-19 immunization. To study the effect of different types of available COVID-19 vaccines in Egypt (AstraZeneca, Sinopharm, Pfizer/BioNTech, and Sputnik) on neutralizing antibodies against COVID-19 in HD and kidney transplantation patients compared with the healthy population. Patients and methods A total of 84 participants; 28 HD patients, 28 kidney transplant recipients, and 28 healthy medical staff members were recruited to test the serological reaction. Six months following the second dose of the COVID-19 vaccine, we evaluated antibody titers against SARS-CoV-2 by Elecsys Anti-SARS-CoV-2 S (Roch) and collected data from the patients, including their comorbidities and the length of time since their kidney transplant. Results All the study groups were comparable as regards age, sex, and BMI, however, hemoglobin was significantly higher in the control group. Antibody response to vaccination was strongest in the control group (100%), followed by HD patients (85%), with transplant recipients showing a significantly weaker response (60%). The Pfizer vaccine generated higher neutralizing antibody levels compared with other vaccines in this study. Yet, the difference was not statistically significant. Additionally, no significant difference in response between the different vaccine types. the transplant group displayed significantly lower levels compared with the control group (P<0.001) and a trend towards lower levels compared with the dialysis group (P=0.06). Conclusion Our study found that all tested vaccines generated comparable levels of neutralizing antibodies in healthy individuals and those with chronic kidney disease (dialysis patients). While 85% of dialysis patients achieved seroconversion (positive antibody test) similar to the healthy control group, only 60% of kidney transplant recipients did. the duration post-transplant may be associated with higher rate of seroconversion. the transplant group displayed lower levels of antibodies compared with the control and the dialysis group which suggests a weaker immune response in transplant patients.

Elrggal M., Zyada R.

Mansour A.E., El Shahawy E.L., Ibrahim M.E., Shahat M.M., Younis D.A.

Background Focal and segmental glomerulosclerosis (FSGS) is a histological pattern used in clinical practice to define a podocytopathy that develops with nephrotic-range proteinuria and segmental obliteration or collapse of glomerular capillary loops with increased extracellular matrix in some glomeruli. The major concerns of idiopathic FSGS are the poor renal prognosis with an absence of response to immunosuppressive therapies or relapses and its recurrence after kidney transplantation in ⁓30–50% of patients, which leads to renal graft failure. The aim of this work is to study the possible role of matrix metalloproteinase inhibitor (doxycycline) in the treatment of primary FSGS. Patients and methods This prospective cohort study was conducted on 100 patients with FSGS. Patients were randomly divided into two equal groups: group 1: patients with FSGS under conventional therapy as a control group. Group 2: patients with FSGS under conventional therapy and doxycycline 100 mg/day for 3 months. Patients were closely monitored for treatment effects and adverse reactions. Clinical, laboratory, and radiological parameters were assessed. Treatment outcomes, including remission of proteinuria and adverse effects, were evaluated. Results Group 2 showed significantly lower levels of triglycerides and fasting blood glucose compared with group 1. Doxycycline-related side effects were observed in some group 2 patients. Both groups showed increased hemoglobin levels and decreased C-reactive protein levels at follow-up. Kidney function tests improved in both groups, with group 2 demonstrating superior outcomes. Group 2 showed higher rates of improvement and lower incidence of end-stage renal disease requiring hemodialysis. Conclusion Adding doxycycline to conventional therapy holds promise for treating primary FSGS. Patients receiving combined therapy exhibited enhanced renal function, reduced proteinuria, and better treatment outcomes.

Tony E.A., Abozaid M.A., Aziz A.A., Abdou M.A., Attia N.M., Othman M.H., Abass W.A., Mostafa M.H.

Background In liver cirrhosis, hemodynamic changes in splanchnic and systemic circulations are involved. Indeed, no established laboratory markers for altered renal hemodynamics in cirrhosis were implicated. The duplex Doppler waveform analysis of intrarenal arteriolar vessels is considered a noninvasive estimate of renovascular impedance and renal arterial vasoconstriction. In particular, the renal resistive index (RRI) is considered as the best reliable indicator of renal blood flow in patients with different diseases. The study aimed to evaluate RRI, serum and urinary cystatin C, beta-trace protein, liver fatty acid protein, and kidney injury molecule-I as noninvasive indicators of altered renal hemodynamics in patients with cirrhosis with normal urea and creatinine. Patients and methods A case–control study included 60 patients with post-hepatitis C virus (HCV) cirrhosis and 40 healthy controls. Serum and urinary biomarkers were measured. Renal color Doppler duplex was used to evaluate RRI. Results Mean serum and urinary biomarkers in HCV patients were significantly higher than controls. Moreover, the RRI was higher in patients than in controls with P value less than 0.001. Rising levels of urea, high direct bilirubin, and hypoprothrombinemia with high serum kidney injury molecule 1 and RRI were significant independent predictors for subsequent kidney injury. Conclusion Urinary kidney injury molecule 1 is a reliable, sensitive, and specific biomarker for the prediction of kidney injury among HCV cirrhotic patients with an obvious superior test performance and specificity to e other biomarkers. An increase in serum kidney injury molecule 1 and RRI were associated with poor prognosis.