Background: Chronic kidney disease is an epidemic global health problem that leads to death. To prevent any disease progression and treatment, the diagnosis must be made in the early stage by studying renal damage. Klotho is a protein found in many organs of the human body, but it is mainly abundant in the kidney. This study aimed to evaluate klotho's clinical significance as an additional biomarker for diagnosing chronic kidney disease in its early stages.   Methods: One hundred subjects were included in this study to measure their serum and urinary klotho. Forty patients with chronic kidney disease (pre-dialysis)  and sixty normal subjects were enrolled in this study. Serum and urinary klotho were determined using the ELISA technique in addition to other renal function tests. Results : Serum and urinary  alpha klotho  were decreased in CKD patients when it compared with control subjects. A positive correlation was found between serum creatinine and urinary alpha klotho in the patients' group. Conclusion: Serum and Urinary alpha klotho levels were decreased significantly in patients with chronic kidney disease compared with healthy controls.

Objective: Anemia, a common complication of chronic kidney disease, usually develops because of erythropoietin defi ciency. Maintaining target hemoglobin (Hb) with minimal variability is a challenge in hemodialysis (HD) patients. The aim of this study is to compare the long-and short-acting erythropoietin erythropoietin stimulating agents such as Mircera and Eprex in achieving these targets. Methods:One hundred (100) patients on regular hemodialysis were complaining of anemia duo to chronic renal failure. The mean age of those patients was 45.66 (17-70 years), divided into two groups: GroupA patients (n=50) that received methoxy polyethyleneglycol-epoetin beta (Mircera) once monthly, and group B (n=50) that received epoetin alfa (Eprex) 3 times per weeks for 6 months, with dose adjustment for individual haemoglobin target (11-12.5g/dl); maximum decrease from baseline 1g/dl. Results:The response rate in the evaluation period was higher in patients treated with methoxypolyethylene glycol-epoetin beta (Mircera) than with epoetin (Eprex) alfa: 36 of 50 (72%) mean Hb concentration (10.51g/dl) versus 29 of 50 (58%) mean Hb concentration (9.81), with statistically signifi cant p-value <0.0001. Conclusions:Treatment with (Mircera) administered intravenously once monthly was superior to treatment with (Eprex) administered subcutaneously three times weekly for maintaining haemoglobin concentrations in patients with chronic kidney disease on hemodialysis.

Background: Patients on long-term hemodialysis are at a higher risk of contracting blood transmitted infections because of their weakened immune systems and frequent interaction with blood, blood products, equipment, and contaminated surfaces. This making them an important population to study the clinical and epidemiological consequences of newly discovered infections like torque teno virus (TTV). Objective: To investigate the frequency of TTV in patients undergoing hemodialysis by molecular method and to find out any association with risk factors and liver function tests. Methods: This cross-sectional study conducted on (100) patients whom attending Hemodialysis Unit at Al-Imamein Al-Kadhimein Medical City in Baghdad, Iraq. The sample of the study consist of (58) males and (42) females, their mean age is (49.97±4.97 SD) years, (50) with viral hepatitis, while (50) without viral hepatitis, for a period from November 2020 to March 2021. Nested polymerase chain reaction (PCR) was used to detect TTV-DNA. TTV genogroup was determined by Sanger sequencing and phylogenetic tree construction. Results: TTV DNA was detected in 81% (81 out of 100) of hemodialysis patients, respectively. However, no significant association was found between demographic data, clinical characteristics and risk factors with TTV infection. Conclusion: This study showed high prevalence of TTV in hemodialysis patients but didn't play a role in liver injury among these patients. Also, based on phylogenetic analysis of the untranslated region (UTR), genogroup-3 was found to be the most prevalent in hemodialysis patients. Keywords: Torque teno virus, hemodialysis, risk factors, liver function, sequencing, phylogenetic tree Citation: Ali HM, Al-Shuwaikh AM, Manuti K. Molecular and phylogenetic detection of Torque Teno Virus (TTV) among hemodialysis patients: A single center study. Iraqi JMS. 2022; 20(1): 11-25. doi: 10.22578/IJMS.20.1.3

Background: Many factors can alter the response to erythropoietin treatment and approximately 5-10% of patients present an evident resistance in response to erythropoietin therapy. These include: iron deficiency, inflammation, infections, malignancy, dialysis, blood loss, hyperparathyroidism, aluminum toxicity and vitamin B12 or folate deficiencies. Objective: To evaluate and search for causative factors that predispose to Anemia resistance to erythropoietin therapy in End stage renal failure patients on regular hemodialysis. Patients and methods: This is descriptive prospective study enrolling 350 patients with End stage renal disease on regular hemodialysis, during January 2019 to January 2020 at Al-Emamain Al-Kadumian Medical City / Nephrology unit. 117 (44 female and 73 male) patients enrolled in this study whom met the inclusion criteria: Hgb level below 11 mg / dl despite adequate erythropoietin dose, regular adequate HD, Iron and folic acid supplementation. Amonthly bases measurement of CBC,

The aim: To determine the prevalence of TTV in patients undergoing hemodialysis and to evaluate the possible risk factors. Materials and methods: This study was conducted in 93 patients, attending hemodialysis unit at AL-Imammain AL-Kadhimain Medical City Hospital for a period from November 2020 to March 2021. The demographic and clinical characteristics including age, sex, underling medical condition, hepatitis B and C status and laboratory tests such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline Phosphatase (ALP) and total serum bilirubin (TSB) were obtained from the record of the patients in hemodialysis unit in the hospital. Direct detection of TTV-Ag was done by enzyme linked immunosorbent assay (ELISA). Results: TTV-Ag was detected in 38 out of 93 (40.9%) hemodialysis patients. Demographic, clinical and risk factors i.e. sex, age, history of diabetes, history of hypertension, history of blood transfusion, number of blood transfusion, the hemodialysis duration, history of surgery and liver enzymes levels did not show significant relation (P>0.05). Conclusions: This study showed high prevalence of Torque Teno virus in hemodialysis patients, however, TTV did not play a role in liver injury among these patients.