it is suggested that GA provides a significantly better measure to estimate glycemic control in HD patients with diabetes and that the assessment of glycemic control by HbA1c in these patients might lead to likely underestimation as a result of the increasing proportion of young erythrocyte by the use of erythropoietin.

Background-It is not clear which serum creatinine-based glomerular filtration rate (GFR) estimating model performs best in kidney donors.

To evaluate the individualization of dialysate sodium (Na + ) concentration in hemodialysis (HD), we studied 40 stable chronic HD patients in a single-blind crossover design. They underwent 36 consecutive HD sessions with the dialysate Na + concentration set at 138 mmol/L, followed by 36 sessions of dialysate Na + set to match the patients average pre-HD plasma Na + levels. We multiplied the midweek pre-HD measured Na + by the Donnan coefficient of 0.95 (individualized Na + ). Pre-HD Na + dialysis sodium levels were nearly constant, with no variation between the two phases and a mean of 137.45 ± 2.04 mmol/L. Post-HD serum Na + was significantly higher during the standard phase (139.7 ± 2 mmol/L) than during the individualized phase (137.1 ± 1.6 mmol/L). Also, interdialytic weight gain (IDWG) was significantly more reduced during the individualized phase (3.25 ± 0.56%) than during the standard phase (3.94 ± 0.92%), P <0.001. Episodes of distressing symptoms including headache, muscle cramps and hypotension were significantly less frequent in the individualized phase. The mean of the pre-HD and post-HD systolic and diastolic blood pressures significantly decreased during the individualized phase, and we could reduce the doses of antihypertensive drugs in 10 (33.33%) patients. Individualized dialysate Na + concentration was associated with a decrease in IDWG and dialysis hypotension and related symptoms and better BP control in stable chronic HD patients.

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 The prevalence of chronic kidney disease is increasing rapidly worldwide, and recent data indicate that overt disease is the tip of the iceberg of covert disease. Data on the prevalence and incidence of proteinuria in young adults are scarce. This lack of knowledge is an obstacle to the establishment of prevention programs for chronic kidney disease, especially in developing countries. SETTING AND PARTICIPANTS Urine screening for proteinuria was carried out in a cohort of young adults in a student hostel of Ain Shams University, Cairo, Egypt. Fresh morning urine samples were collected and tested for proteinuria by dipstick analysis. Participants with persistent proteinuria were referred to the university hospital for further evaluation for the presence of kidney disease. RESULTS Of 1,260 apparent healthy students screened, 67.7% were males and 32.3% were females. Their mean age was 20.2 ± 1.2 years. 3.3% were hypertensive, and proteinuria was detected in 47 (3.7%) in the first screening test. At the second screening test, persistent proteinuria was found in 10 students (0.8% of the original cohort). Of these, 4 (0.3%) had proteinuria more than 0.5 g/24 h, but all of them refused renal biopsy. CONCLUSIONS Urine dipstick is an inexpensive way to screen for proteinuria in developing countries, but it must be done twice to exclude transient and intermittent proteinuria. Routine screening for proteinuria in this particular young adult population is not recommended due to its low diagnostic yield.