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.

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.

Background Detachment of podocytes represents a turning point in the development of glomerular sclerosis and consequently, of CKD progression. Furthermore, detachment may differentiate minimal change disease (MCD) cases—which have only podocyte effacement—from early focal segmental glomerulosclerosis (FSGS) in which effacement and detachment are observed by electron microscopy. Noteworthy, it is not uncommon for early FSGS to present with clinical presentation and light microscopy (LM) pictures identical to MCD. In our routine practice, we often find cells that lie freely in Bowman’s space by LM. In this study, we try to determine whether these cells are detached podocytes that are worth reporting or just an artifact that can be ignored. Methods To the best of our knowledge, no study has discussed the accuracy of LM in detecting detached podocytes by the routinely used stains. We retrospectively selected 118 cases that were diagnosed as MCD by LM, and searched for detached cells in Bowman’s space in their archived, routinely stained LM slides. After that, we tried to find any correlation between the clinical course, detached cells in LM picture and the EM reports. Results LM can significantly detect detached podocytes with a positive predictive value of 93%, specificity of 85%, and sensitivity of 46%. Significant correlations were found between detached cells and degree of proteinuria and late steroid resistance. Conclusion  Detecting detached podocytes by LM is a specific finding that must be reported whenever detected, as it predicts response to steroids and may be able to differentiate MCD from early FSGS by identifying patients who could have podocytopenia.

Background Endothelial dysfunction is the primary step for the development of CKD-related cardiovascular disease. Early prediction and management can influence patient survival. Serum testing of FGF 23 hormone and urinary phosphate excretion were studied as predictors of all-cause cardiovascular morbidity in CKD patients; however, their relation to endothelial dysfunction is controversial. A combination of both in one index is hypothesized to increase their sensitivity in detecting endothelial dysfunction, especially in the early stages of CKD before the dominance of hyperphosphatemia, the original risk. Methods A cross-sectional comparative analysis between thirty CKD stage 3 patients and sixty stage 4–5 CKD patients was conducted. All patients were tested for markers of mineral bone disorders including serum FGF 23 and 24-h urinary phosphate excretion. A combination of both in one index (nephron index) is calculated and hypothesized to correlate with nephron number. Endothelial dysfunction was assessed by measuring the post-occlusion brachial flow-mediated dilatation (FMD). Results In univariate and multivariate regression analyses, the nephron index was the only predictor of endothelial dysfunction in individuals with stage 3 CKD (r = 0.74, P 0.01). This was not applied to stage 4–5 CKD patients where serum phosphorus (r = − 0.53, P 0.001), intact PTH (r = − 0.53, P 0.001), uric acid (r = − 0.5, P 0.001), and measured GFR (r = 0.59, P 0.001) were the highest correlates to FMD; the Nephron index had the weakest correlation (r = 0.28, P = 0.02) and is not predictive of endothelial dysfunction. Conclusion Nephron index calculation showed better correlation with endothelial dysfunction than using any of its determinants alone in early stages of CKD when FGF 23 levels are just beginning to rise. In advanced CKD patients, hyperphosphatemia, hyperparathyroidism, hyperuricemia, and measured GFR are more reliable than nephron index.

Conclusions:Our study has the potential for residual confounding from the limited collection of co-morbidity and non-evaluation of severity, and lack of socioeconomic, medication and biochemical data in analyses. Our study indicates that survival outcomes on dialysis are improving with time. This includes survival for patients with medical comorbidity. Compared to previously, the survival of such patients is not meaningfully different on PD versus HD at the current time. This is probably as a result of improved pre-dialysis care, patient selection (eg dialysis versus conservative care in the elderly) but could due to improvements in general care of patient co-morbidities and improvements in dialysis technology and practice.