to examine: (1) trends of IDWG among patients in relation to different variables and comorbidities e.g. age, hypertension, diabetes, CV disease...etc.; (2) associations of high IDWG with frequency of hospitalization due to systemic volume overload and the need for extra dialysis sessions, and (3) the impact of high IDWG on the frequency of intradialytic hypotension (IDH). Methods: One hundred and twenty maintenance HD patients were enrolled in this study. All patients had been receiving HD for at least 3 months, on a 4 hour, thrice weekly basis. The data collected included; age, gender, duration on HD (in months), pre-and post-HD body weights (on 3 successive sessions), pre-and post-HD blood pressure (BP) measurements (on 3 successive sessions), the type of vascular access and the average blood flow rate, dialysis efficiency (based on average Kt/V), and the presence or absence of residual kidney function.The presence of various comorbidities has been recorded including; diabetes, hypertension, coronary artery and peripheral vascular diseases, heart failure, cerebrovascular disease, and other disorders. The estimated IDWG was calculated based on the average between pre-and post-dialysis weights that were recorded on 3 consecutive dialysis sessions. The estimated IDWG was expressed in kilograms and as a percentage of the patients' dry weight. We considered an estimated average IDWG of 4% as a cutoff value between low and high IDWG. We defined IDH as the drop of systolic blood pressure of 20 mmHg or more during HD compared to the predialysis blood pressure and/or a systolic blood pressure that is less than 90 mmHg. Results: We have recorded that 50.0% of those younger than 55 years had IDWG $ 4%. On the other hand, only 31.7% of those aged 55 years or more had IDWG $ 4% (p¼0.041). There was no significant gender difference regarding IDWG. Among those who had IDWG $ 4%, 81% of these patients had at least one hospital admission due to volume overload or the need for extra HD session(s). On the other hand, only 19% of those having IDWG < 4% had been admitted or got extra HD sessions (p<0.001). Of those who were admitted (over 12 months) due to volume overload; 74.1 % had IDWG $ 4%, while 25.9% had IDWG < 4% (p< 0.001). Regarding IDH, 87% of patients having IDWG $ 4% had at least one episode of IDH/week. On the other hand, only 22.5% of those with IDWG < 4% had one episode of IDH/week (p<0.001). When analyzing those who had at least one IDH episode/ week; 72.9% of them had IDWG $ 4%, while only 27.1% had IDWG < 4% (p<0.001).Introduction: Identification of new clinical indicators for ideal dialysis is an interest. Erythrocyte glutathione transferase (e-GST) is non-dialyzable enzyme compartmentalized in the red cells. It may act as ligandins by binding and sequestering a variety of small or large toxic compounds and peptides. The aim of the study was to verify whether e-GST is able to assess hemodialysis adequacy among different treatment modalities, as a complementary to the Kt/V urea parameter. Methods: This cross secti...

Background and Aims Non-alcoholic fatty liver disease (NAFLD) is associated with endothelial dysfunction which is a common problem in hemodialysis patients and a risk for high cardiovascular mortality in hemodialysis. Thrombomodulin is a promising marker of endothelial cell injury in different pathological conditions. This study evaluates the additive effect of non-alcoholic fatty liver disease (NAFLD) in prevalent HD patients on endothelial dysfunction. Methods A case-control study was conducted on 60 end-stage renal disease (ESRD) patients on conventional hemodialysis: group A: 30 patients with NAFLD, group B: 30 patients without NAFLD, and control group of 30 apparently healthy subjects. Excluding elderly, diabetic patients, chronic Liver disease, advanced heart Failure, active infection, COVID-19 infection, autoimmune diseases and patients with hemodialysis catheters. Thrombomodulin was measured for all participants by ELISA technique. Results Thrombomodulin could detect endothelial dysfunction in patients with NAFLD at Cut off value &lt;0.8 ng/ml with sensitivity 53.33%, specificity 80%, PPV 72.7%, and NPV 63.2%. On comparing Thrombomodulin in patients with NAFLD (4.378±3.762 ng/ml), Non-NAFLD (1.126±0.591 ng/ml), and control (0.755±0.314 ng/ml) there was a significant difference (P-value&lt;0.001). Post hoc analysis showed significantly high Thrombomodulin levels in patients with {NAFLD versus Non-NAFLD} and {NAFLD versus control} with p-value&lt;0.001, 0.001 respectively while there was no significant difference between patients with Non-NAFLD and control p-value 0.792. NAFLD patients with positive thrombomodulin have a risk of 2.5 times having endothelial dysfunction. There was no significant correlation between Thrombomodulin and all variables in the study. Conclusions Thrombomodulin can be used as specific marker for endothelial dysfunction in hemodialysis patients with Non Alcoholic fatty liver disease.

Department of Internal Medicine & Nephrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.

Background and Aims End stage renal disease (ESRD) is chronic inflammatory condition which affects iron parameters. Serum soluble transferrin receptor (sTfR) is a reliable indicator for assessing iron status in inflammatory conditions. This study evaluates the usefulness of serum sTfR in iron deficiency anemia detection in prevalent hemodialysis patients. Method This case-control study included 40 ESRD patients on conventional hemodialysis with CRP&gt;10, 40 ESRD patients with CRP&lt;10 and 8 apparently healthy controls. Serum sTfR was measured for all patients and controls. Results STFRs predicts iron deficiency anemia in prevalent hemodialysis patients at cut off value 12.5 mg/l with area under curve 0.949, sensitivity 88.75, specificity 100, PPV 100% and NPV 47.1%. The prevalence of STFRs in patients with CRP&lt;10 was 85%, while in patients with CRP&gt;10 was 92.5% (P-value 0.288). Patients who have elevated STFRs have risk 1.22 times to have iron deficiency anemia if CRP &lt;10 (odds ratio: 1.22) and 3.14 times if CRP&gt;10 (odds ratio: 3.14). There was significant difference on comparing patients with CRP&lt;10, CRP&gt;10 and control as regard haemoglobin and STFR with P-value 0.0001 and 0.0001 respectively. Post Hoc analysis showed significant difference between the patients with CRP&lt;10 and control also in patients with CRP&gt;10 and control as regard haemoglobin and STFR (p value &lt;0.0001). on comparing patients with CRP&lt;10 with patients with CRP&gt;10 there was significant difference in STFRs p value 0.0001 despite no significant difference in haemoglobin (p value 0.642) and classic iron markers (s.iron, TIBC, TSAT) with p value 0.701, 0.192, 0.382 respectively. Serum STFRs was negatively correlated with s.iron and Kt\v in patients with CRP &lt;10 (r -0.372, P-value 0.018) and (r-0.416, p value 0.008) respectively. Conclusion Serum soluble transferrin receptor is a highly sensitive and specific marker of iron deficiency anemia in hemodialysis patients especially with high CRP level.

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