Sleep disorders are common among the patients undergoing dialysis in end stage renal disease (ESRD). Although variable, their prevalence has been reported to be higher when compared to the general population. The most frequently reported complaints are insomnia, restless leg syndrome (RLS), sleep-disordered breathing and excessive daytime sleepiness (EDS). The aim of this study was to assess the prevalence of sleep disorders in end stage renal disease patients on regular hemodialysis (group I with 30 patients) and CKD patients (group II with 30 patients) in comparison to 30 normal population (control group). In addition to laboratory investigations which included creatinine clearance using Cockroft and Gault formula, hemoglobin level (Hb), blood urea, serum creatinine, serum albumin, serum calcium and phosphorus and lipid profile, all subjects underwent one night of laboratory-based polysomnography (PSG) consisting of a standard montage of electroencephalography (EEG) (C3/A1 and O2/C3 or O1/C4), monopolar left and right electrooculography (EOG) referenced to the opposite mastoid, surface mentalis electromyography (EMG), respiratory airflow (measured by thermistor) and effort (piezoelectric sensors), electrocardiography (ECG), anterior tibialis EMG and pulse oximetry. For hemodialysis subjects, this study was performed on a night immediately following hemodialysis treatment. The results showed that patients on hemodialysis have sleep disorders, and that sleep disorders are common in group I and II than control group. The percentage of sleep disorders in hemodialysis patients were as follows: insomnia (69%), followed by obstructive sleep apnea syndrome OSAS (24%), RLS and periodic limb movement PLM (18%), nightmares (13%), EDS (12%), sleepwalking (2%), possible rapid eye movement behavior disorders RED (2%), possible narcolepsy (1.4%). While the percentage of sleep disorders in CKD patients were as follows: insomnia (54%), followed by RLS (19%), PLM (12%), OSAS (16%), nightmares (15%), EDS (15%), sleepwalking (4%), possible RBD (3%), possible narcolepsy (1%). There was inverse correlation between sleep disorders and Hb, albumin and creatinine clearance; also there was positive correlation between sleep disorder and phosphorus. We concluded that the sleep disorders are common in CKD patients either on conservative management or on regular hemodialysis. Treatment of anemia, hyperphosphatemia and hypoalbuminemia may improve sleep disorders among those patients.

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

Contrast-induced nephropathy (CIN) is the third leading cause of acute kidney injury (AKI) in hospitalized patients. Diabetes mellitus remains a consistent independent predictor of contrast nephropathy. Aim: To determine frequency and predictors of contrast-induced nephropathy after cardiac catheterization in type II diabetic patients. Patients and methods: The study included 200 type II diabetic patients who underwent cardiac catheterization; serial measurement of serum creatinine and creatinine clearance (Before contrast exposure and 48 h), creatinine clearance was calculated using Cockcroft-Gault formula. Contrast-induced nephropathy was defined as rise in serum creatinine 48 h after contrast exposure of !0.5 mg/dL or increased425% compared to base line creatinine. Results: incidence of CIN in type II diabetic patients was 21.5%; incidence of CIN in diabetic patients with microalbuminuria was 17%, while incidence of CIN in patients with macroalbuminuria levels was 26%. There was a statistically significant difference between the patients who suffered from CIN post-procedure and patients who did not suffer from CIN regarding the ejection fraction and age with low ejection fraction and older patients in CIN group. Multiple logistic regression analysis for CIN predictors showed that pre-contrast serum creatinine to be the strongest predictor for being at risk of contrast-related, followed by age, and lastly albumin/creatinine ratio. Conclusion: Our findings suggest that diabetic patients, despite having a normal baseline creatinine are at an increased risk of developing CIN post-coronary angiography, patients at risk of CIN are older patients with high pre-contrast serum creatinine and high urine albumin/creatinine ratio.

Background: There are various changes in the thyroid gland and its function in end stage renal disease (ESRD). It is not surprising that impairment of kidney function leads to disturbed thyroid physiology. Objective: Is to detect thyroid function abnormalities in hemodialysis patients. Patients and Methods: 100 patients on maintenance hemodialysis (HD) were enrolled, they were excluded if they had the following criteria: history of thyroid disease, thyroid and parathyroid surgery, under interferon therapy, exposed to radiation, antithyroid drugs or thyroid replacement therapy, and those under 30 years. They were subjected to history taking, clinical examination and laboratory investigations including hepatitis C virological state, renal functions and thyroid functions. Results: 92% of patients had normal thyroid-stimulating hormone (TSH) levels, 8% had abnormal TSH levels. Regarding fT3 levels, 67 % had normal fT3 while 33 % had abnormal fT3, and only 11 patients had abnormal fT4. In respect to the thyroid hormone status, only one was hyperthyroid, 92% were in euthyroid status, 2% were clinically hypothyroid, 5% were subclinically hypothyroid, and 1% was hyperthyroid. There was significant negative correlation between TSH levels and dialysis duration, 8 patients having abnormal thyroid functions ere females, and 60% had HCV positive status. No significant associations were found between HCV infection and the thyroid hormones levels. However, HCV positive patients experienced lower levels of T4 and TSH. Conclusion:The average percentage of patients under regular hemodialysis with abnormal thyroid state is 8% with females having abnormal fT4 and TSH levels compared to males. TSH levels were inversely correlated with dialysis duration.