Volume 4 Issue 1

Research Article: Evaluation of the Phosphocalcic Profile of Chronic Hemodialysis Patients in Chad

Mahamat Abderraman. G1, Ibrahim Hamat2, Zeinab MM. Tondi3, Hissein A. Mahamat1, Bery Mbaitelssem1 and Kossi A. Sabi4

Introduction: Mineral-Bone Disorders associated with Chronic Kidney Disease (MBD-CKD) lead to life-threatening clinical complications in patients with chronic renal failure. Several studies had shown that serum concentrations of calcium, phosphorus and Parathyroid Hormone (iPTH) were controlled in only a few hemodialysis patients. In Chad, this study was initiated for the first time to evaluate the phosphocalcic profile of chronic hemodialysed patients of N'Djamena.
Methodology: This was a cross-sectional, descriptive, analytical study carried out over 6 months (February 15 to August 15, 2015) in the hemodialysis units of the General Hospital of National Reference and the Renaissance Hospital of N'Djamena. Were included all chronic hemodialysis patients for at least 6 months whose records included serum calcium, phosphatemia, vitamin D 25 OH and intact parathyroid hormone.
Results: Fifty-two (52) out of 90 files were selected. The sex ratio was 0.92. The average age was 50.04 years [18 and 84 years]. Diabetic nephropathy, nephroangiosclerosis and indeterminate nephropathy accounted for respectively 40.4% (n = 21), 23.1% (n = 12) and 32.7% (n = 17). The seniority in hemodialysis was 35.4 months [8 months - 204 months]. The average duration of hemodialysis sessions was 9.24 hours per week [8-10 hours]. Hypocalcaemia was noted in 23 patients (44.2%). Mean phosphatemia was 41.93 mg/l [11.56 - 110 mg/l]. It was noted that 30.8% of patients had normal phosphatemia. Hyperphosphatemia was observed in 22 patients, as 42.3%. In bivariate analysis, the association between phosphatemia and bone pain was statistically significant (p = 0.031). The average concentration of 25 (OH) D was 20.75 ng / ml [11.56 - 38.10 ng / ml]. Deficiency of 25 (OH) D was noted in 92.3% of patients. Secondary hyperparathyroidism (PTHi > 500 pg/ml) was observed in 14 patients, as 27%.
Conclusion: The prevalence of MBD-CKD was 57.5%. The compliance rate of the indicators compared to the recommendations KDIGO 2009 state of the order of 30.8% for phosphatemia; 48.1% for total serum calcium; 25% for the PTHi and 7.7% of the 25 (OH ) vitamin D.
Keywords: MBD-CKD; Dialysis; N'Djamena; Chad

Cite this Article: Mahamat Abderraman G, Hamat I, Moussa Tondi ZM, Mahamat HA, Mbaitelssem B, et al. Evaluation of the Phosphocalcic Profile of Chronic Hemodialysis Patients in Chad. Int J Nephrol Ther. 2018;4(1): 012-015.

Published: 16 April 2018

Research Article: Triple Drug Regimen as Induction Treatment of Lupus Nephritis: a Pilot Randomized Controlled Trial

Arpita Roy Chowdhury*, Subho Banerjee, Rayees Yousuf, Dipankar Sircar and Rajendra Pandey

The management of Proliferative Lupus Nephritis (PLN), in spite of the progressive enlargement of the drug armamentarium, remains a challenge and is largely unsatisfactory. Balancing the immunosuppression and the risk of infection is like a tight rope walk. Although pulsed doses of cyclophosphamide in conjunction with steroids (the 'NIH' protocol) remains the standard of care in most centers, several newer options have become available to the treating physicians [1]. The low dose cyclophosphamide regimen, Mycophenolate Mofetyl (MMF), calcineurin inhibitors and more recently the multitarget therapy regimen have had reasonable success in induction of complete or partial remission in PLN [2-6]. The Induction therapy is particularly important for treating this severe disease because the patients with complete remission typically have a better prognosis, with fewer episodes of relapse, than the patients who do not achieve remission.

Cite this Article: Chowdhury AR, Banerjee S, Yousuf R, Sircar D, Pandey R. Triple Drug Regimen as Induction Treatment of Lupus Nephritis: a Pilot Randomized Controlled Trial. Int J Nephrol Ther. 2018;4(1): 007-011.

Published: 19 February 2018

Research Article: Is 25- Hydroxy Vitamin D a Real Index of Vitamin D Status in Pre-Dialysis Chronic Kidney Disease Patients?

Ahmed Fayed, Mahmoud M. El Nokeety, Ahmed A. Heikal, Hany Hammad, Dina O. Abdulazim, Mona M. Salem, Mervat M. Naguib, Usama A. Sharaf El. Din* : on behalf of the Vascular Calcification Group (VCG)

Background: The prevalence of vitamin D deficiency among chronic kidney disease (CKD) patients is high worldwide. Diagnosis of vitamin D status is based on the estimation of serum 25-hydroxy vitamin D (25 OH D) level.
Objective: We looked for the different determinants of serum 25 OH D among pre-dialysis stage 3-5 CKD patients.
Patients and Methods: 1624 stage 3-5 CKD adults (689 male and 935 female) were selected beside 200 normal control subjects. Patients and control subjects were tested for Body Mass Index (BMI), Serum Urea Nitrogen (BUN), Creatinine, Calcium (Ca), Phosphorus (P), Parathormone (PTH), 25 OH vit D, albumin, and Uric Acid (UA), urine Albumin/Creatinine Ratio (ACR), and estimated Glomerular Filtration Rate (eGFR). Beside all these parameters we studied serum fibroblast growth factor-23 (FGF23) in further 100 CKD cases.
Results: Optimal level of vitamin D is encountered in 1.4% of CKD patients' vs 52% of the control. 1107 (68.2%) of CKD patients vs 23 (11.5%) of the control group had serum 25(OH) vit D = 20 ng/mL (mean ± S.D = 16.8 ± 5.8 vs 37.3±7.6 ng/mL for CKD vs control group respectively, P < 0.001). There is a significant positive correlation between serum 25(OH) vit D and serum Ca (r = 0.299, P < 0.001), and significant negative correlation between serum 25 OH vit D on one hand, and serum P, PTH, UA, and urine ACR on the other (r = -0.46, -0.69, -0.73, and -0.8 respectively, P < 0.001). On the other hand, BMI, age and FGF-23 did not have significant correlation with 25 OH vit D. Multivariate linear regression model confirmed these significant associations.
Conclusion: Low serum 25 OH vit D is very common among CKD patients. Serum P, UA, and urine ACR are the most important determinants of serum 25(OH) vit D. These results might cast a doubt on the significance of serum 25 OH vit D as diagnostic measure of vitamin D status among pre-dialysis CKD patients.

Cite this Article: Fayed A, El Nokeety MM, Heikal AA, Hammad H, El. Din UAS, et al. Is 25- Hydroxy Vitamin D a Real Index of Vitamin D Status in Pre-Dialysis Chronic Kidney Disease Patients? Int J Nephrol Ther. 2018;4(1): 001-006.

Published: 04 February 2018

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