Background and Aims: Women in the childbearing period on hemodialysis (HD) have decreased fertility when compared with the general population. However, pregnancy in this patients’ population is still possible. The aim of the current study was to assess the conception rate in Egyptian HD females. Methods: The study comprises 2 phases: phase one studied the frequency of conception in HD females in Egypt, while phase two studied the live birth frequency and factors affecting it in 22 hemodialysis units (HDUs) including 211 females with sexually active partner in their childbearing period comprising 33 females with HD coincidental pregnancies. Results: 5-year conception rate was 5.2%, and was associated with higher planned dialysis dose (higher blood flow rate, larger dialyzer size, and session length), better control of blood pressure, as well as a lower level of serum ferritin. Live birth frequency was 33.3% and was statistically significantly associated with younger age of the pregnant lady, higher length of dialysis sessions, lower serum phosphorus level, and suggested better nutrition. There was no maternal mortality associated with HD coincidental pregnancies. There was a better neonatal outcome observed with the caesarian section. Conclusion: Fertility is possible and safe in Egyptian HD female with a sexually active partner as there is no maternal mortality but not as such for the fetal outcome. Better conception potentials and the outcome are related to better-planned dialysis dosing and adequate control of phosphate and inflammation.
BackgroundIn dialysis patients, the obesity-survival paradox still requires an explanation. Anemia and high doses of erythropoiesis-stimulating agents (ESAs) are associated with worse outcomes in the hemodialysis (HD) population. In the present study, we explored the relation between obesity and anemia control in a sample of maintenance HD patients in Egypt.MethodsThis multicenter observational study included 733 patients on maintenance HD from 9 hemodialysis centers in Egypt. Clinical and laboratory data as well as average doses of ESAs and parenteral iron were recorded. The erythropoietin resistance index (ERI) was calculated.ResultsObesity, defined as a body mass index (BMI) ≥ 30 kg/m2, was present in 22.6% of the studied population. The target hemoglobin level (10.0–11.5 g/dL) was achieved in 27.3% of non-obese and 25.3% of obese patients, with no significant difference. The median serum ferritin and the values of transferrin saturation index did not differ significantly between these two groups. The weekly ESA dose was significantly lower in obese than in non-obese patients (P = 0.0001). A trend toward higher ESA doses and ERI values was observed in patients with lower BMIs (P < 0.0001). Multiple linear regression revealed that the BMI and urea reduction ratio were the strongest predictors of the ERI.ConclusionOur study adds more evidence to obesity-associated advantages in HD patients. BMI may determine ESA response, with better responses observed in patients with higher BMIs.
Background: End-stage renal disease (ESRD) is an important cause of global morbidity and mortality affecting both sexes. Both genders may present with different symptoms and signs, respond differently to therapy and may exhibit different degrees of tolerance towards their disease. In Egypt, hemodialysis (HD) constitutes the most common modality of renal replacement therapy and the number of hemodialysis patients is increasing. The objective of the present study was to investigate gender-related differences in clinical and biochemical characteristics in HD patients. Mortality events in both genders were also recorded and predictors of mortality in the included HD population were explored. Methods: This multicenter study adopted essentially a cross-sectional design and included 2158 patients (1241 males and 917 females) undergoing HD in 25 hemodialysis units in six governorates in Egypt. The study started at June 2016 till May 2017. Data were extracted from the patients' records. One year mortality events in the included HD patients were prospectively observed and recorded. Results: Males on HD had a significantly lower body mass index (BMI) values and were less efficiently dialyzed. Their blood pressure measurements were significantly higher. In addition, males had significantly higher serum albumin with a significantly lower serum potassium level. The overall mortality rate was 6.9% (149 deaths) during the one year follow up period with a significant male predominance (7.9% in males vs. 5.6% in females p=0.03). The mortality rate was highest within the first 14 months after starting hemodialysis therapy. Mortality was statistically significantly higher in patients with diabetes, ischemic heart disease (IHD), anemia with low hemoglobin, and low serum albumin. The mortality risk is nearly duplicated in HD patients with IHD, while low serum albumin was associated with about 3 times an increase in mortality risk in the studied HD patients. Conclusion: Gender differences in clinical and laboratory characteristics and mortality do exist in Egyptian HD patients and should be considered when management guidelines are developed to suit the gender-related variations.
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