Background: Older patients are now the rule rather than the exception in hemodialysis (HD). Cognitive impairment is common among persons with end stage renal disease (ESRD) and is associated with poor outcomes. Aim: To assess the prevalence of cognitive impairment among older adults on HD and the association of different patients' demographics and characteristics with cognitive impairment. Materials and methods: A cross section study was conducted to assess the cognitive functions of elderly subjects on HD. 94 subjects, 60 years old and above, were included. All subjects were subjected to: 1-comprehensive geriatric assessment. 2-Laboratory investigations including: hemoglobin, serum creatinine, serum urea, serum potassium, serum sodium and serum albumin. Kt/V as a marker of dialysis adequacy was calculated. Results: The study revealed that 26 (27.7%) patients had normal cognitive function, 32 (43%) had mild cognitive impairment, 21 (23%) had mild dementia, 8 (8.5%) had moderate dementia and 7 (7.4%) had severe dementia. Older age, low education level and longer duration of dialysis history were found to have significant associations with cognitive impairment, [P: < 0.001, 0.002, and 0.012 respectively]. While hemoglobin, serum albumin, serum creatinine, serum urea, serum potassium and Kt/V showed no significant association with cognitive impairment, Serum sodium and dry weight dialysis showed significant difference between patients with normal cognitive function and patients with cognitive impairment, [P <0.001 both]. Conclusion: Cognitive impairment is prevalent in Egyptian older adults on HD and more prevalent and severe in those with older age, low education, lower level of serum sodium, longer duration of dialysis history and higher dry weight.

To determine the frequency of Rheumatic and Musculoskeletal Diseases (RMDs) in patients with renal failure on regular hemodialysis. Methods and findings: The present study included forty-nine patients (28 males and 21 females) with renal failure on regular hemodialysis. Full history taking and clinical examination were documented for all patients. Blood samples were collected for laboratory investigations before the midweek session. Dual Energy X-ray Absorptiometry (DXA) was performed to all patients to assess bone mineral density (BMD). Kt/V was used as a marker of dialysis adequacy. Mean age for all patients was 54.41 ± 15.9 years, and the dialysis duration was 3 ± 2.3 years. The detected RMDs included (in order of descending frequency): fibromyalgia syndrome (51%), myalgias (37%), arthralgia (37%), flexor tenosynovitis (29%), cramps (29%), ectopic calcifications (25%), flexion deformity of the elbow (16%), carpal tunnel syndrome (14%), destructive spondyloarthritis (8%) and Vasculitis (4.1%). Positive anti-CCP was detected in 1 female and rheumatoid factor in 4 females and 1 male. The BMD was reduced with the DXA t-score at lumbosacral spine, hip and forearm-1.5 ± 1.8,-1.7 ± 1.6,-1.9 ± 1.9 respectively. Overall, there was a tendency to a higher frequency of musculoskeletal findings in males. Other co-morbidities included: diabetes mellitus (45%), hypertension (96%), cardiovascular (33%), cerebrovascular stroke (6%), hyperuricemia (37%), hepatitis C (16%) and amyloidosis (8%). Conclusion: Rheumatic and musculoskeletal diseases are frequent and overlooked among hemodialysis patients especially males and usually associated with chronic pain.

Anti-glomerular basement membrane (GBM) disease is a rare cause of acute renal failure and known to have bad prognosis regarding renal functions recovery and patient survival specially when diagnosed late and presents with severe renal failure that requires dialysis. We report a case of 11-year-old child with acute renal failure secondary to anti-GBM disease and associated with antineutrophil cytoplasmic antibody-positive vasculitis. He was treated with plasmapheresis, steroids, and cyclophosphamide with recovery of his kidney functions.

Introduction: Patients with end-stage kidney disease (ESKD) suffer from functional iron deficiency where despite the presence of sufficient iron stores in the body, adequate iron is unavailable for heme synthesis. This study hypothesis was that in patients undergoing hemodialysis (HD), administration of intravenous (IV) ascorbic acid (AA) exerts a good effect on the management of anemia, either by increasing the mobilization of iron from tissue stores or acting as an antioxidant to overcome the inflammatory block and increase the erythropoietin sensitivity. Methods: Fifty patients with ESRD who were on regular HD were included in the study. Patients' ferritin levels ranged from 500 to 1200 ng/mL with transferrin saturation of 30% or more. However, all patients were anemic and received erythropoietin therapy. Iron therapy was discontinued in the first group, whereas it was continued in the second group that received IV AA. Results: A significant increase in the levels of Hb was observed in the second group after 6 months despite the decrease in ferritin levels in both the groups. Transferrin saturation decreased in both groups, the decrease being more in the first group. The levels of C-reactive protein (CRP) decreased in the second group, whereas these increased in the first group. Conclusions: Intravenous AA as an adjuvant therapy with iron exerts a favorable and significant effect on the Hb, serum ferritin, and CRP levels in patients with ESKD having anemia. The discontinuation of iron therapy only decreases the serum ferritin levels and does not improve the Hb or CRP levels.

BackgroundPain is a significant problem in more than 50% of hemodialysis patients and is not being effectively managed1. In patients on regular dialysis, musculoskeletal pain was identified as the most disturbing pain and the majority reported that pain limited their daily life activities2ObjectivesThe aim of the study is to detect and describe the incidence of musculoskeletal manifestations, comorbidities and gender differences in renal failure patients on regular hemodialysisMethodsForty-nine patients with renal failure and on regular dialysis were included in the present study. The patients were subjected to full history taking and clinical examination. Blood samples were collected before the mid-week session for laboratory investigations. The bone mineral density (BMD) was assessed by dual energy X-ray absorptiometry (DXA) in all patients. Kt/V was used as a marker of dialysis adequacyResultsThe 49 patients mean age was 54.41±15.9 years. They were 28 males and 21 females. The dialysis duration was 3±2.31 years. Comorbidities were present as diabetes (45%), hypertension (96%), cardiovascular (33%), cerebrovascular stroke (6%), hyperuricemia (37%), hepatitis C (16%) and amyloidosis (8%). The following musculoskeletal findings were present in descending frequency: fibromyalgia syndrome (51%), myalgias (37%), arthralgia (37%), flexor tenosynovitis (29%), cramps (29%), ectopic calcifications (25%), flexion deformity of the elbow (16%), carpal tunnel syndrome (14%), and destructive spondyloarthritis (8%). Vasculitis was present in 2. Positive anti-CCP was present in 1 female and rheumatoid factor in 4 females and 1 male. Otherwise, there was a tendency to a higher frequency of musculoskeletal findings in males. Vitamin D insufficiency (25.1±14.6ng/ml) and reduced bone mineral density were present. The DXA t-score at lumbosacral spine was -1.51±1.77, hip (-1.65±1.59) and forearm (-1.89±1.9).ConclusionsMusculoskeletal manifestations and comorbidities are frequent and overlooked in hemodialysis patients especially males and the associated chronic pain may affect their quality of life.ReferencesDavison SN. Pain in hemodialysis patients: prevalence, cause, severity, and management. Am J Kidney Dis. 2003;42(6):1239–47.Gamondi C, Galli N, Schönholzer C, Marone C, Zwahlen H, Gabutti L, et al. Frequency and severity of pain and symptom distress among patients with chronic kidney disease receiving dialysis. Swiss Med Wkly. 2013;143:w13750Disclosure of InterestNone declared