Renal transplantation as a modality of treatment, in ESRD patients, is superior to hemodialysis in terms of cognitive performance improvement.

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Background: Hyperuricemia is commonly associated with hypertension. Also, it is well known to coincide with the metabolic syndrome but is still not recognized as a risk factor. So, we aimed to evaluate hyperuricemia among a sample of hypertensive Egyptians with normal renal function. Methods: this study was performed on 303 hypertensive patients aged 30-69 years. Patients were divided into 2 groups according to the level of uric acid: group 1 composed of 168 hypertensive hyperuricemic patient sand group2 composed of 135 hypertensive normouricemic patients. All patients were subjected to complete medical history and detailed clinical examination including body mass index (BMI), complete blood count (CBC), serum creatinine, BUN, FBS, cholesterol, triglycerides, uric acid, sodium, potassium, urinary uric acid, urinary creatinine, urinary uric acid to creatinine ratio and fractional excretion of uric acid(FEUA). Results: The overall prevalence of hyperuricemia was 55.4%. Uric acid correlated significantly with age (p<0.05). BMI was significantly higher in group1 than in group 2(p<0.05), and there was a significant positive correlation between serum uric acid and BMI (p<0.01).Serum triglycerides and cholesterol were significantly higher in group 1than in group 2 (p<0.05for both) denoting risky metabolic effects. Serum uric acid correlated significantly with systolic blood pressure (p<0.05), but not with diastolic blood pressure. No significant difference found between group 1 and group 2 as regards SBP, DBP or blood pressure control(all p values>0.05). Serum uric acid found to correlate significantly (p<0.001) with urinary uric acid, urinary creatinine and negatively with FEUA denoting early tubular defect of the kidney. Also, Urinary uric acid, urinary creatinine and urinary uric acid/creatinine ratio were higher in group 1than in group 2 (p values were<0.001, <0.001 and <0.05 respectively). FEUA was found to be significantly lower in group 1 than in group 2 (p<0.01). We found, also, that serum sodium level was significantly higher in the hyperuricemic group than in the normouricemic group (p<0.001) denoting the role of Na + in the development of hypertension and defective renal excretion of uric acid. Conclusion: We conclude that the incidence hyperuricemia in our sample of Egyptian hypertensive patients was (55.4%). Impaired renal clearance of uric acid occurs before deterioration of GFR. Serum uric acid should be measured in all cases of hypertension together with BMI, total cholesterol, triglycerides and should be treated to avoid consequent metabolic complications. Hypertensive patients with hyperuricemia should be warned strictly of high sodium diet.

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BACKGROUND AND AIMS Immunoglobulin light chains are classified as middle molecule uremic toxins and its removal through effective dialyzer is needed with less albumin loss. This study assessed the free light chains removal using dialyzer surface area (SA) 2.6m2 in high flux dialysis (HD) versus hemodiafiltration (HDF) and its relation to cumulative albumin loss. METHOD A cross-over study included 25 patients who underwent hemodialysis using dialyzer surface area 2.6 m2 in high flux HD followed by online post-dilution hemodiafiltration with washout period 2 weeks using high flux dialyzers (max 2.0 m2 SA). All patients were subjected to single session measurement of dialysate albumin every hour and pre-post dialysis Free light chains (FLC) kappa and Lambda by ELISA. RESULTS Dialyzer (SA) 2.6m2 showed significant reduction in post-dialysis kappa and lambda in comparison to pre-dialysis level in high flux hemodialysis and hemodiafiltration (P &lt; 0.001). HDF showed higher kappa and lambda FLC reduction ratio (45.16 ± 6.53 ng/mL), (28.68 ± 4.36 ng/mL), respectively compared with high flux HD (29.52 ± 6.38 ng/mL), (19.48 ± 1.96 ng/mL), respectively (P &lt; 0.001). HDF/HD fold change of kappa and lamda were (1.56 ± 0.23) and (1.48 ± 0.26), respectively. Patients on HDF dialysis had significant total albumin loss in dialysate [median (IQR) 2.47 (1.16) gm/dL] compared with high flux dialysis [median (IQR) 0.65 (0.64) gm/dL] with (P &lt; 0.001). Maximum albumin loss in patients on HDF was in the first hour [median (IQR) 1.22 (0.59)] gm/dL with lower albumin loss in the next hours reaching median {0.17 (0.15) gm/dL} in the fourth hour. Trans-membrane pressure was positively correlated with total albumin loss in high flux hemodialysis and hemodiafiltration (r 0.443, p 0.027, r 0.745, P = 0.001), respectively. CONCLUSION High flux dialyzer 2.6 m2 (SA) is effective for free light chains removal especially with online post-dilution hemodiafiltration with acceptable albumin loss.