Correlation between DKK-1 Level and Bone Density Status in Children on Maintenance Haemodialysis

Background: Renal osteodystrophy (ROD) is a bone disorder resulting from chronic kidney disease (CKD) and related metabolic diseases. Dickkopf-related protein-1 (DKK-1) is critical in regulating bone biology. This study aimed to evaluate the serum DKK-1 level as a bone marker in children with CKD who undergo regular hemodialysis (HD). Subjects and Methods: This case-control study involved 40 children with CKD on HD and 40 healthy children as controls. The study measured serum DKK-1 levels and performed a dual-energy X-ray absorptiometry scan (DEXA) in line with routine laboratory investigations. Results: There was a significant increase in the serum level of DKK-1 in the patient group compared to the control group. The DKK-1 levels were 2540.65 (2215.4 - 2909.2) pg/ml and 1110.45 (885.45 - 1527.65) pg/ml, respectively, with a p-value of less than 0.001. In the hemodialysis group, 25 patients (62.5%) had low bone mineral density (BMD) with a Z-score of under -2.0. Eighteen of these patients had low BMD in both the neck of the femur and lumbar spines. Additionally, there was a significant increase in serum DKK-1 level in patients with low BMD (2567.35 (2303.8 - 3108.1) pg/ml) compared to patients with normal BMD (2454 (1859 - 2820) pg/ml) (p = 0.041). There was also a significant positive correlation between DKK1 level and phosphorus, alkaline phosphatase, and Parathormone serum levels. In conclusion, the study indicates a clear correlation between DKK-1 and BMD in children undergoing maintenance hemodialysis. DKK1 is a promising biomarker for CKD-MBD.

Role of Lung Ultrasound in the Assessment of Hydration Status of Chronic Haemodialysis Patients

Background: Fluid overload is frequent in Haemodialysis (HD) and is one of the major factors of cardiovascular morbidity and mortality for chronic HD patients. The main challenge with chronic haemodialysis patients is indeed the maintenance of a normal extracellular volume through dry weight determination. Our study aimed at assessing the role of lung ultrasound in the detection of B-lines for the determination of hydration status in chronic HD patients. Methods: We conducted a cross-sectional study including 31 patients undergoing chronic HD treatment for at least 3 months, in the Yaounde University Teaching Hospital dialysis unit. Lung ultrasonography and clinical examinations were performed immediately before dialysis, and 30 minutes after dialysis. Differences between clinical and ultrasound variables before and after dialysis were measured to assess the effects of dialysis. Association between categorical variables was assessed with the Chi-squared test or Fischer test, and Rho’s Spearman coefficient for quantitative variables. Results: There was a reduction in the median of B-lines score after dialysis [12 (7 - 26) versus 8 (5 - 13)], clinical score [2 (1 - 3) versus 0 (-1 - 2)], mean of systolic blood pressure (164.74 ± 26.50 versus 158.48 ± 27.89), frequency of dyspnoea in patients (32.3% versus 6.5%);and raising of the frequency of cramps in patients (0% versus 19.4%) and all statistically significant (p ≤ 0.031). B-lines score before and after dialysis was associated with dyspnoea and raised jugular venous pressure (p Conclusion: Lung ultrasound for the detection of B-lines reflects the variation of extracellular volume during dialysis and can even capture pulmonary oedema at a pre-clinical stage. It is then a reliable and sensible method for assessing extravascular lung water and thus hydration status of haemodialysis patients. It could constitute a better alternative for an objective and accurate definition of dry weight, specifically in the African and Cameroonian context, with its assets being low cost, availability, and easiness to perform in a large population of HD patients. We, therefore, recommend further multicentric studies in order to design a standardized protocol of ultrasound follow-up for all chronic HD patients’ hydration status assessments.

Single-Centre Descriptive Epidemiological Study of Emergency Haemodialysis Patients in the Haemodialysis Unit of the CHU Point G (Mali)

Introduction: Haemodialysis is an exchange of solutes and water between the patient’s blood and a dialysis solution with a composition close to that of normal extracellular fluid, through a semi-permeable membrane. It is used in the treatment of acute or chronic renal failure. The aim was to study the clinical and paraclinical aspects and the outcome of patients starting dialysis treatment for renal failure in an emergency setting. Method: This was a prospective study from 1 January to 31 July 2020, with a sample of 62 patients receiving haemodialysis in an emergency setting in the nephrology department of the Point G University Hospital. Results: The study showed that the sex ratio was 1.38 in favour of men and that the mean age of patients was 36.82 years. The group of patients with a low socio-economic standard of living dominated, accounting for 71% of cases. Hypertension and anaemia were the predominant risk factors in 77.4% and 87.3% respectively. Hyperphosphaemia, hypocalcaemia and secondary hyperparathyroidism accounted for 94.7%, 98.2% and 97.7% respectively. Left ventricular hypertrophy was 29.27% on electrocardiogram and 22% on cardiac ultrasound. Isolated cardiomegaly was found in 30.76% of patients. The main indications for dialysis were uraemic syndrome (69.2%), pericardial friction (27.4), anuria for 48 hours (20.1%), hyperkalaemia (17.7%) and acute lung oedema (16.1%). The mean duration of haemodialysis was less than one month in one out of two cases. There was no significant association between age and time on dialysis (p = 0.178). The death rate was 20.97%. Case fatality was higher in patients whose duration of dialysis was less than one month than in the others (p = 0.0006). Conclusion: CKD is a public health problem in Mali. It affects young people, especially males. Low economic income is an obstacle to the management of this disease.

Prevalence of occult hepatitis B virus infection in haemodialysis patients from central Greece

AIM:To assess the hepatitis B virus(HBV)-DNA and the prevalence of occult HBV infection in end-stage renal failure(ESRF)patients from Central Greece. METHODS:Sera from 366 ESRF patients attending five out of six dialysis units from Central Greece were investigated for HBV-DNA by real-time polymerase chain reaction.Only serum samples with repeatedly detectable HBV-DNA were considered positive.IgG antibodies to hepatitis C virus(anti-HCV)were tested by a third generation enzyme linked immunosorbent assay(ELISA),while IgG antibodies to hepatitis E virus (anti-HEV)were tested by two commercially available ELISAs.RESULTS:HBV-DNA was detected in 15/366 patient (4.1%)and HBsAg in 20/366(5.5%).The prevalenc of occult HBV infection was 0.9%(3/346 HBsAg negative patients).Occult HBV was not associate with a specific marker of HBV infection or anti-HCV o anti-HEV reactivity.There was no significant differenc in HBV-DNA titres,demographic and biochemica features,between patients with occult HBV infectio and those with HBsAg-positive chronic HBV infection. CONCLUSION:In central Greece,4%of ESRF patient had detectable HBV-DNA,though in this setting,th prevalence of occult HBV seems to be very low(0.9%).

The Effect of Exercise Therapy on Physical Function, Biochemistry and Dialysis Adequacy in Haemodialysis Patients: A Systematic Review and Meta-Analysis

Background:Patients undergoing dialysis have high mortality rates and a unique risk factor profile. Some improvements elicited by exercise training have been shown in dialysis populations, here we aimed to further explore the bene-fits of exercise. As well as changes in physical fitness we quantified cardiac function, depression, serum biochemistry, dialysis adequacy and energy intake following exercise training in people with chronic kidney disease (CKD) undertaking dialysis. Methods:A systematic literature search was completed in December 2012 identifying randomized, controlled trials of exercise training studies in haemodialysis (HD) patients. A subsequent meta-analysis was conducted.Results: Twenty four studies were included, totalling 879 patients. Exercise training produced significant improvements in physical fitness: peak VO2 5.03 mlO2·kg-1·min-1 (95% CI 3.73, 6.33, p 0.0001), Knee extensor strength 2.99 kg (95% CI 0.46, 5.52, p = 0.02) and 6 minute walk distance 60.7 metres (95% CI 18.9, 103, p = 0.004). Significant increases in energy intake MD 238 Kcal·day-1 (95% CI 94, 383, p = 0.001), serum Interleukin-6 MD-0.58 pg·ml-1 (95% CI-1.01, -0.15, p = 0.008) and Creactive protein MD 0.92 mg/L-1 (95% CI 0.29, 1.56, p = 0.004), but not Albumin or BMI, were reported. Improved Beck Depression scores were reported MD-6.9 (95% CI-9.7,-4.1, p 0.00001). Dialysis adequacy was reduced MD-0.23 (95% CI -0.29, -0.17, p 0.00001), while serum potassium was higher MD 0.14 mmol·L-1 (95% CI 0.01, 0.27, p = 0.04). Moreover exercise training appeared safe, with no direct exercise-associated deaths in over 30,000 patient-hours. Conclusions: Our pooled analyses confirmed improvements in physical fitness following exercise training and suggested additional improvements in dialysis efficiency (kt/v), serum potassium, inflammation and depression in HD patients.

Concordance between bio-impedance analysis and clinical score in fluid-status assessment of maintenance haemodialysis patients: A single centre experience

BACKGROUND The burden of chronic kidney disease(CKD)is rising rapidly globally.Fluid overload(FO),an independent predictor of mortality in CKD,should be accurately assessed to guide estimation of the volume of fluid to be removed during haemodialysis(HD).Clinical score(CS)and bio-impedance analysis(BIA)have been utilized in assessment of FO and BIA has demonstrated reproducibility and accuracy in determination of fluid status in patients on HD.There is need to determine the performance of locally-developed CSs in fluid status assessment when evaluated against BIA.AIM To assess the hydration status of patients on maintenance HD using BIA and a CS,as well as to evaluate the performance of that CS against BIA in fluid status assessment.METHODS This was a single-centre,hospital-based cross-sectional study which recruited adult patients with CKD who were on maintenance HD at Kenyatta National Hospital.The patients were aged 18 years and above and had been on maintenance HD for at least 3 mo.Those with pacemakers,metallic implants,or bilateral limbs amputations were excluded.Data on the patients’clinical history,physical examination,and chest radiograph findings were collected.BIA was performed on each of the study participants using the Quantum®II bio-impedance analyser manufactured by RJL Systems together with the BC 4®software.In evaluating the performance of the CS,BIA was considered as the gold standard test.A 2-by-2 table of the participants’fluid status at each of the CS values obtained compared to their paired BIA results was constructed(either++,+-,--or-+for FO using the CS and BIA,respectively).The results from this 2-by-2 table were used to compute the sensitivity and specificity of the CS at the various reference points and subsequently plot a receiver operating characteristic(ROC)curve that was used to determine the best cut-off point.Those above and below the best CS cut-off point as determined by the ROC were classified as being positive and negative for FO,respectively.The proportions of participants diagnosed with FO by the CS and BIA,respectively,were computed and summarized in a 2-by-2 contingency table for comparison.McNemar’s chi-squared test was used to assess any statistically significant difference in proportions of patients diagnosed as having FO by CS and BIA.Logistic regression analysis was conducted to assess whether the variables for the duration of dialysis,the number of missed dialysis sessions,advisement by health care professional on fluid or salt intake,actual fluid intake,the number of anti-hypertensives used,or body mass index were associated with a patient’s odds of having FO as diagnosed by BIA.RESULTS From 100 patients on maintenance HD screened for eligibility,80 were recruited into this study.Seventy-one(88.75%)patients were fluid overloaded when evaluated using BIA with mean extracellular volume of 3.02±1.79 L as opposed to the forty-seven(58.25%)patients who had FO when evaluated using the CS.The difference was significant,with a P value of<0.0001(95%confidence interval:0.1758-0.4242).Using CS,values above 4 were indicative of FO while values less than or equal to 4 denoted the best cut-off for no FO.The sensitivity and specificity for the CS were 63%and 78%respectively.None of the factors evaluated for association with FO showed statistical significance on the multivariable logistic regression model.CONCLUSION FO is very prevalent in patients on chronic HD at the Kenyatta National Hospital.CS detects FO less frequently when compared with BIA.The sensitivity and specificity for the CS were 63%and 78%respectively.None of the factors evaluated for association with FO showed statistical significance on the multivariable logistic regression model.

Correlation between Residual Renal Function and Hypertension in Regular Haemodialysis Patients

Objective: To evaluate the correlation between residual renal function and hypertension in regular haemodialysis patients. Background: Initiating chronic dialysis treatment gives end-stage renal disease patients a new lease on life. However, the annual mortality rate in dialysis patients is ~20% and quality of life is substantially reduced. Patients and Methods: This study was carried out on a reasonable number of subjects on regular haemodialysis divided into two groups. All were given informed consent and, the study was approved by the ethics committee of Menoufia University. Results: There was significant relation between presence of residual renal function and hypertension in patients with ESRD on regular haemodialysis, but the relation between residual renal function and control of hypertension is not statistically significant. 40% of group 1 were hypertensive, 66.7% of group 2 patients were hypertensive, the interdialytic weight gain mean was 1.42 in group 1 and 2.37 in group 2. Control of hypertension was achieved in 63.6% of group 1 patients by one drug, 27.3% patients by 2 drugs;however 9.1% of patients need 3 drugs to control their blood pressure, while in group 2 40% of patients were controlled by one drug, 45% with 2 drugs and 15% need 3 drugs to control blood pressure. Conclusion: There is significant relation between presence of residual renal function and hypertension in patients with ESRD on regular haemodialysis, but the relation between residual renal function and control of hypertension is not statistically significant.

Design and application of weight gain graphs based on Bandura’s self-efficacy theory for patients on maintenance haemodialysis

Purpose:To design interdialytic and daily weight gain graphs for patients on maintenance haemodialysis and to evaluate their effect on patient adherence to restricted fluid intake.Methods:Forty-five patients on maintenance haemodialysis were recruited from August to October 2012.The graphs were applied for 12 weeks based on Bandura’s self-efficacy theory.Adherence to restricted fluid intake,dialysis adequacy,and satisfaction were compared before and after the graphs were applied.Results:Adherence to restricted fluid intake increased from 53.3%to 91.1%;the mean rate of urea clearance(Kt/V)decreased from 1.197 to 1.311,and the qualified rate increased from 42.5%to 70%.The rate of adherence was 86.77%;acceptance and satisfaction rates were 100%.Conclusion:It is acceptable to apply the graphs clinically for subsequent effective improvement of adherence to restricted fluid intake,promoting dialysis adequacy,and increasing patient satisfaction.Therefore,clinical application of the graphs is worthwhile.

Oxidative DNA Damage Is Elevated in Renal Patients Undergoing Haemodialysis

Background: End stage renal disease (ESRD) is associated with an increase in oxidative stress, cardiovascular disease and cancer. The main treatment for ESRD is haemodialysis (HD), which itself induces repetitive bouts of oxidative stress through membrane biocompatibility and endotoxin challenge. The resulting higher levels of reactive oxygen species in turn produce increased levels of oxidative DNA damage leading to genomic instability which may influence the higher risk of cancer reported in HD patients. Our aims were to measure levels of oxidative DNA damage in HD patients and in age and gender matched control volunteers. Methods: Thirty eight patients receiving HD in the Western Health and Social Services Trust (WHSCT) and 8 healthy volunteers were recruited. Volunteers gave informed consent and non-fasting morning blood samples were taken and assessed for DNA disruption using the comet assay modified to identify oxidative specific damage. Results: The HD patients had significantly elevated levels of alkaline DNA damage (19.46% ± 1.37% vs 3.86% ± 1.36% tail DNA, p < 0.05) and oxidative DNA damage formamidepyrimidine DNA glycosilase (5.81% ± 1.08% vs 1.23% ± 0.43% tail DNA, p < 0.01) and endonuclease III (6.04% ± 1.00% vs 1.98% ± 0.70% tail DNA, p < 0.01) compared to controls, respectively. A positive correlation was observed between the duration on dialysis (months) and levels of Endo III specific damage (p = 0.041). Conclusion: The significant increase in oxidative DNA damage and the positive correlation with duration of HD treatment and Endo III damage may contribute to the increased cancer risk observed in this patient group. Studies are required to investigate the best way to reduce this damage.

The Efficacy and Safety of Saxagliptin in Haemodialysis Patients

Introduction: Good glycaemic control without causing excessive hypoglycaemia reduced the risk of macrovascular and microvascular complications in type 2 DM patients on regular haemodialysis (HD). The objectives of this study were to assess the efficacy and safety of add-on saxagliptin to insulin therapy in blood sugar control compared to insulin therapy alone in diabetic patients undergoing HD. Design and Methods: In this prospective open-labelled randomized controlled trial, HD patients with type 2 DM and on stable insulin therapy with HbA1c 7% - 13% were randomized to receive add-on saxagliptin 2.5 mg once daily to insulin therapy or insulin therapy only for 12 weeks. Results: 24 patients were randomized into each arm equally. Baseline and week-12 serum HbA1c, fructosamine, fasting blood glucose (FBS) and mean self monitoring blood glucose (SMBG) were comparable in the groups. Reduction of HbA1c and mean SMBG were significant in both groups. There was a significant drop in fructosamine levels (p = 0.004) and trend of lower FBS (p = 0.097) in add-on saxagliptin group but not in insulin alone group. The incidence of hypoglycaemia was the same in both groups. Conclusion: Add-on saxagliptin to insulin is comparable to insulin therapy alone in blood sugar control in regular HD patients and is safe and generally well tolerated. Add-on saxagliptin group may have more persistent and less fluctuation of glucose control compared to insulin only group.

Monitoring Frequency of Haemoglobin, Calcium and Phosphorus and the Impact on Correction in Patients on Maintenance Haemodialysis in Douala-Cameroon

Background: There is scarcity of data on the actual frequency of routine blood work-up for patients on maintenance haemodialysis and how this affects the achievement of therapeutic goals in sub-Saharan Africa. This study aimed to review these in a referral hospital in Cameroon. Methods: A prospective hospital-based cohort study carried out from November 2019 to April 2020 including patients on maintenance haemodialysis in Douala general hospital. Patients were followed during 6 months to determine the frequency of monitoring of haemoglobin, serum calcium and phosphorus. Targeted values for haemoglobin were ≥10 g/dL, 80 - 100 mg/L for serum calcium and 25 - 45 mg/L for serum phosphorus. Pearson correlation test was used to define the correlation between monitoring frequencies and blood values at the end of the study. Results: For all 154 patients included in the study, the median frequency of monitoring for haemoglobin was once every 8 week (IQR: 6 - 12) and once every 12 weeks (IQR: 8 - 24) for serum calcium and phosphorus. The proportion of patients who achieved haemoglobin, serum calcium and phosphorus targets at the end of the study were 27.4%, 63% and 74% respectively. No correlation was found between the frequency of monitoring and the haemoglobin, serum phosphorus and calcium levels at the end of the study. Conclusion: The frequency of monitoring of serum haemoglobin, calcium and phosphorus by patients in this study was low with a high prevalence of patients not achieving target value.

Spectrum of Neurological Disorders amongst Patients on Maintenance Haemodialysis in Douala, Cameroon: A Cross-Sectional Study

Context: Neurologic disorders are common in patients on maintenance haemodialysis (MHD). Data in Sub-Saharan Africa are scarce. Aim: To determine the prevalence and associated factors of neurological disorders amongst patients on MHD in Cameroon. Settings and Design: This was a four-month cross-sectional study carried out at the Douala General Hospital (DGH) a tertiary referral hospital in Cameroon. Methods: The diagnosis of neuropathy was made using the Michigan Neuropathy Screening Instrument (MNSI), neuropathic pain with the DN4 score, Restless Legs Syndrome (RLS) with the International Restless Legs Syndrome Study Group questionnaire (IRLSSG) and cognitive disorders with the Mini-Mental State Examination test (MMS). Student T and Chi-square tests were used to compare qualitative and quantitative variables. The level of significance was set at p Results: A total of 157 patients were included with 65% being males. The mean age was 48.8 ± 13.7 years. The main comorbidities were hypertension (90.4%), diabetes (19.1%), hepatitis C (10.5%) and HIV infection (10.8%). The median dialysis vintage was 36 (1 - 178) months. The overall prevalence of neurological disorders was 85.4%. The leading type was sensory polyneuropathy (57.3%), cognitive dysfunction (52.9%), neuropathic pain (23%), and restless legs syndrome (17.8%). Male gender was statistically associated with neuropathic pain, while age ≥ 40 years and diabetes were associated with sensory neuropathy and RLS. Conclusions: The burden of neurological disorders is high among patients on MHD as up to 4/5 of them had neurological involvement dominated by sensory polyneuropathy and cognitive dysfunction.

Adherence Factors Affecting Kidney Transplant Recipient among Patients on Maintenance Haemodialysis in Cote d’Ivoire

Background: Kidney Transplantation is the best treatment for patients in end stage renal disease. It’s a new therapeutic approach for such patients in Cote d’Ivoire which is expected to develop. Aim: Determine the adherence factors affecting kidney transplant recipient among patients on maintenance haemodialysis in Cote d’Ivoire and point out possible obstacles to the development of this new practice in the country. Patients and Methods: This was a cross-sectional study carried out from May to June 2016 in the Haemodialysis Centres of Abidjan. Any patient aged ≥18 years, on haemodialysis for at least 6 months, who signed the inform consent were subjected to a questionnaire. None of the respondents had been transplanted. The subjects addressed in the document were sociocultural status, opinion related to kidney transplantation and willingness to be transplanted or not and the reasons. A statistical analysis was performed to determine factors associated with kidney transplantation desire. Results: We included 295 (71.53% males) patients, with a mean age of 44.53 ± 12.09 years. Among this population, 36.61% had a higher level of education, 70.85% were Christians, 66.44% lived with partners, 56.61% had no income and 74.92% were treated in Public Health Centres. The median duration on dialysis was 34 months. A total of 287 (97.29%) patients had already heard of kidney transplantation among which 149 (51.94%) for the first time after initiation of haemodialysis. There was 231 (78.31%) patients willing to be transplanted with only 91 (39.39%) of them having a potential living donors. The main motivations were the desire to stop dialysis (52.38%) and the search for a better quality of life (41.13%). Among the 64 (21.69%) patients unfavourable to renal transplantation, 45.31% raised its higher cost compared to haemodialysis. Duration on haemodialysis (>34 months) was significantly higher in patients willing to be transplanted compare to non-applicants (51.95% versus 37.50%, p 34 months) (OR = 2.12 CI: 1.15 - 3.88 p = 0.01) and the Christian religion (OR = 0.43 CI: 0.20 - 0.92 p = 0.03). Conclusion: Almost all patients on maintenance haemodialysis were willing to be transplanted. However, the rate of living donor remains insufficient. For the non-seekers, the high cost of the process remains the main obstacle to kidney transplantation. Transplantation should be given more attention and political support economically by the Government to allow its development in Cote d’Ivoire.

Revaccination after Acute Kidney Injury Associated with Prior COVID-19 Vaccination: Case Report

Background: Acute kidney injury associated with proteinuria has been reported following vaccination against SARS-CoV-2 several times since 2021. Decisions about subsequent revaccination in these patients have been difficult because of the uncertainty of the consequences of doing so, and the absence of publications to help determine whether revaccination may be considered safe or not. Purpose: We present a case report of a 59-year-old Canadian man who developed severe acute kidney injury associated with moderate proteinuria following his first COVID-19 vaccine with the Moderna vaccine (an mRNA vaccine). He required haemodialysis for 2 weeks, which was initiated when his creatinine reached 1002 μmol/l. A kidney biopsy showed changes consistent with acute tubular necrosis. The patient was cautioned that repeat vaccination might result in further kidney injury which might be irreversible. However, he badly wanted to attempt a second COVID-19 vaccination, to facilitate a family vacation across several countries in Europe, at a time when travel restrictions were in place in many countries for persons who had not completed a course of vaccines. Method: Following deliberations, the patient chose to try a different type of Covid-19 vaccine. On this occasion, he was vaccinated with the Novavax vaccine (a subunit COVID-19 vaccine). Following this, close monitoring of his urine to detect proteinuria and blood testing for acute kidney injury were carried out on days 1, 3, 7, and 60 after vaccination. Furthermore, a year after his repeat vaccination, his kidney function and urinalysis were again assessed. Result and Conclusions: The patient did not develop acute kidney injury or worsening proteinuria following repeat vaccination. It remains unclear if acute kidney injury with proteinuria is caused by Covid-19 vaccination, or simply an incidental association. This case report suggests that it is may be reasonable for patients with acute kidney injury after COVID-19 vaccination to consider trying a different type of vaccine. In situations where a new virulent strain of virus emerges or in patients at risk of severe complication from infection, it may be reasonable to consider revaccination following appropriate counselling with close monitoring of renal function.

Effects of Salivae Miltiorrhizae Liguspyragine Hydrochloride and Glucose Injection(参芎葡萄糖注射液)on the Levels of Main Platelet Thrombin Receptors in Chronic Haemodialysis Patients

Objective：To investigate the effects of Salvia Miltiorrhiza Liguspyragine Hydrochloride and Glucose Injection（参芎葡萄糖注射液,SLGI） on the expression of platelet membrane receptors proteinase-activated receptor-1（PAR1） and proteinase-activated receptor-4（PAR4） in end-stage renal disease（ESRD） patients on chronic haemodialysis（HD）.Methods：Eighty-six ESRD patients on HD（treated group） were treated with SLGI,7 days as one therapeutic course,for two successive courses.The previous therapies were unchanged.Flow cytometry was used to assess the expression of platelet PAR1 and PAR4 in the patients,and turbidity method was used to determine the platelet maximum aggregation rate（MAR）.Meanwhile,renal function was measured.The final data were compared with those before treatment and with those in the normal control group（54 healthy subjects）.Results：Compared with the normal control group,the expressions of PAR1 and PAR4 and platelet MAR in ESRD patients on HD was significantly higher before treatment（P=0.001,P=0.006, and P=0.008）;after treatment with SLGI,the above indices in patients were remarkably decreased（P=0.036 and P=0.046）,except PAR4（P=0.067）,but still higher than those in the normal control group,however,it was not statistically significant.Conclusions：（1） The overexpression of PAR1 and PAR4 might lead to increased platelet aggregation and this could be one of the reasons for the thrombotic events in ESRD patients on HD.（2） SLGI was able to down-regulate the expression of PAR1 in ESRD patients on HD,improve platelet function,and regulate platelet activation.

Prevalence of the Functional Dyspepsia and Associated Factors in the Chronic Hemodialysis Patients of the National Teaching Hospital “HKM” of Cotonou

Aim: To study the functional dyspepsia in chronic hemodialysis patients of CNHU-HKM of Cotonou. Methods: This descriptive, analytical and cross-sectional study ran from 1 September 2013 to 28 February 2014 in the University Clinic of Nephrology Dialysis of CNHU-HKM of Cotonou. It included all chronic renal failure patients on hemodialysis for at least 9 months prior to the survey. After identifying the patients with upper gastrointestinal disorders, we had submitted to clinical Rome III criteria for functional dyspepsia. Upper endoscopy was performed in patients with clinical criteria of functional dyspepsia. Clinical factors associated, paraclinical and therapeutic were sought by logistic regression in univariate analysis. Data were analyzed using EPI DATA version 3.1. Results: 1) One hundred and thirty-one haemodialysis patients had participated in the study (sex ratio: 1.5, average age 49.6 ± 12.4 years). 2) The prevalence was 71.8% for upper gastrointestinal disorders, 64.9% for dyspeptic syndrome and 1.5% for functional dyspepsia. 3) They were associated to clinical criteria of functional dyspepsia of Roma III, the presence of high blood pressure, hypocalcaemia, treatment with calcic inhibitors and iron supplementation. Conclusion: Functional dyspepsia is uncommon in hemodialysis. The search of an organic cause is imperative for every dyspepsia.

Renal transplant recipient seizure practical management

Seizures are not uncommon in renal transplant patients.The common aetiologies are metabolic disturbance associated with renal failure,immunosuppression and associated complications and infections.Their management can be challenging because of altered pharmacokinetics of antiepileptic drugs(AEDs)and their removal by dialysis.A practical approach to the management of seizure in renal transplant patients is discussed.This review highlights the guidelines for use of various AEDs in renal transplants.

Metformin toxicity: A meta-summary of case reports

BACKGROUND Metformin is arguably the most commonly prescribed oral hypoglycemic agent for the management of diabetes.Due to the lack of randomized control trials,most of the data pertaining to the clinical course,therapeutic interventions and outcomes of patients with metformin induced toxicity has come from case reports or series.AIM To analyse the symptomology,clinical interventions and outcomes of patients presenting with severe metformin toxicity by reviewing the published case reports and series.METHODS We performed a systematic search from PubMed,Science Direct,Reference Citation Analysis(https://www.referencecitationanalysis.com/)and Google Scholar databases using the terms“metformin”AND“toxicity”OR“overdose”OR“lactic acidosis”OR“hyperlactatemia”.The inclusion criteria were:(1)Case reports or case series with individual patient details;and(2)Reported toxicity or overdose of metformin in adults,published in the English language.Data regarding baseline demographics,clinical presentation,therapeutic interventions,intensive care unit course and overall outcome were collected.RESULTS Two hundred forty-two individual cases were analysed,from 158 case reports and 26 case series,with a cumulative mortality of 19.8%.214(88.4%)patients were diabetics on metformin.57(23.6%)had acute ingestion,but a great majority(76.4%)were on metformin in therapeutic doses when they developed toxicity.Metformin associated lactic acidosis(MALA)was the most commonly reported adverse effect present in 224(92.6%)patients.Most of the patients presented with gastrointestinal and neurological symptoms and a significant number of patients had severe metabolic acidosis and hyperlactatemia.The organ support used was renal replacement therapy(RRT)(68.6%),vasopressors(58.7%)and invasive mechanical ventilation(52.9%).A majority of patients(68.6%)received RRT for toxin removal,renal dysfunction and correction of MALA.Patients with lowest pH and highest serum lactate and metformin levels also had favourable outcomes with use of RRT.CONCLUSION Most of the reported cases were on therapeutic doses of metformin but developed toxicity after an acute deterioration in renal functions.These patients may develop severe lactic acidosis,leading to significant morbidity and need for organ support.Despite severe MALA and the need for multiple organ support,they may have good outcomes,especially when RRT is used.The dose of metformin,serum pH,lactate and metformin levels may indicate the severity of toxicity and the need for aggressive therapeutic measures but may not necessarily indicate poor outcomes.

Quality of Life of Chronic Haemodialytic Patients at Cotonou Teaching Hospital (BENIN)

Introduction: The objectives of this work were to assess haemodialytic patients’ quality of life (QoL) and to identify factors affecting this QoL. Patients and Methods: It was a three (03) month monocentric and transversal study (from October 24, 2011 to January 27, 2012) conducted in the haemodialysis unit at Hubert Koutoukou Maga Teaching Hospital (CNHU-HKM) in Cotonou. Patients included were residents of Benin, aged 18 years and above, chronic haemodialysis in this unit for over 3 months, and willfully gave their consent. Quality of life was evaluated using questionnaire on Kidney Disease Quality of Life Short-Form French version 1.2 (KDQoL-SF 36). Epidemiological data, nephropathy etiologies and purification parametres were recorded in patients files. Data statistical analysis was performed using SPSS software 11.5. Results: In total 131 patients were involved in the study. The average age was 50.27 ± 12.17 years with a sex ratio of 1.69. Nephroangiosclerosis was the 1st cause. Most patients 128 (97.71 %) received two haemodialysis sessions on weekly basis. The Average Overall Score (AOS) based respectively on SF 36 and KDQoL was 48.55 and 58.55. The average of both SF 36 and KDQoL AOS was 53.55. Factors affecting hemodialytic patients quality of life were vitality, limitations related to mental health and physical condition, burden of kidney disease, effect of the disease on daily life and occupational status. The study revealed that: Patients education level was correlated with vitality

Drug-Eluting Stent for the Treatment of Early Fistula Failure

Introduction: Morbidity and mortality in chronic haemodialysis patients is related to dialysis efficiency. Several complications may occur with vascular access, usually associated with a stenosis. This is known to occur frequently in the venous outflow. Stenosis of the arterial side is not as frequently discussed, but it is also likely to compromise fistula function. Traditionally, surgical and percutaneous interventions have been used to treat failing fistulas, but the employment of drug-eluting stents for the treatment of failing fistulas due to the arterial stenosis has been described rarely. Methods: A 65-year-old male patient referred to our ambulatory because of hand ischemia during haemodialysis treatments only few days after radial-cephalic fistula creation. After physical and echo-color-doppler examination, angiography was performed and percutaneous intervention was proposed. After the positioning of a guiding catheter, the lesion was crossed with a 0.014” guide wire followed by direct drug-eluting stent implantation. Results: Final angiogram showed a good result and a preserved flow through the fistula. Six months later the patient was asymptomatic and the fistula was still working. Conclusion: Although further prospective studies are necessary, percutaneous transluminal angioplasty (PTA) with drug-eluting stents implantation could be considered a safe and effective technique for the treatment of arteriovenous fistulas stenosis.