Papers by Magdy El-Sharkawy
Nephrology Dialysis Transplantation, Jun 1, 2020
Background and Aims Volume overload is considered as an important clinical problem in HD patients... more Background and Aims Volume overload is considered as an important clinical problem in HD patients. It is associated with morbid situations such as pulmonary hypertension and lung congestion. to assess the effect of increased (IDWG) on pulmonary hypertension, and lung congestion. Method This observational cross sectional study was conducted at on 60 HD patients, that were divided into Group I: 30 patients with an IDWG < 3.5% and, Group II: 30 patients with an IDWG > 3.5% of their dry weight. Pulmonary artery pressure was measured by echo and patients classified according to PAP into mild, moderate and severe pulmonary hypertension. Lung congestion in all patients was measured by lung ultrasound and patients classified into minimal, mild, moderate and severe lung congestion. Results Our study showed that pulmonary hypertension prevalence was 30% while lung congestion was 100%. Patients with increased IDWG > 3.5% (group 2) had pre HD higher PAP than those with IDWG < 3.5% (group 1) and patients with IDWG > 3.5% had more change in their PAP post HD session than those with IDWG < 3.5% but no significant difference between the change after the HD session in both groups. HD duration is an important factor in PH development over years. There is a significant relation anemia and hypercalcemia with PH. Patients with more increased IDWG > 3.5 % (group 2) had higher pulmonary congestion than those with IDWG < 3.5% (group 1) and patients with IDWG < 3.5% had more change in their lung congestion level after the HD session than those with IDWG > 3.5% but no statistical significance between the change in both groups. There was a significant relation between HD therapy duration with pulmonary congestion measured prior to the session. Conclusion on the short term increased IDWG affect lung congestion more than pulmonary hypertension.
QJM: An International Journal of Medicine, Oct 1, 2021
Background: Cardiovascular disease (CVD) is present in > 50% of patients undergoing dialysis and ... more Background: Cardiovascular disease (CVD) is present in > 50% of patients undergoing dialysis and the relative risk of death due to CVD events in HD patients is reported to be 20 times higher than in the general population. In fact, in patients on renal replacement therapy (RRT) the prevalence of coronary heart disease and ventricular hypertrophy has been described to be 40% and 70% respectively, other CVD events include hypertention, arrhythmias, valvular calcification and arterial stiffness. Objective: To detect the prevalence of arterial stiffness among end stage renal disease patients on prevalent hemodialysis with hyperparathyroidism. Patients and Methods: This observational cross sectional study was conducted on 60 prevalent hemodialysis patients attending at hemodialysis unit of Ain Shams University hospitals, with convenient sampling method. The included patients are clinically stable on thrice weekly hemodialysis sessions for 4 hours per session. Results: The Dual Pulse Wave Doppler (DPWD) method we proposed in this study may be considered as a useful and convenient option for clinical local Pulse Wave Velocity (PWV) measurement, this clinical practical and reproducible method had the capability to detect an increased local PWV of LCCA (which reflect arterial stiffness) in the patients with PTH > 300 more than the patients with PTH < 300 as it showed that in Group B (PTH>300), the measured carotid artery local PWV values ranged from 6.22 m/s to 8.84 m/s and the mean value was 7.81 6 0.72 m/s, which was higher than 6.72 6 1.06 m/s (ranging from 4.48 m/s to 8.44 m/s) of Group A (PTH<300). Conclusion: Our study showed that there is a high prevalence of arterial stiffness in prevalent hemodialysis patients.
Journal of diabetes & metabolism, Dec 11, 2015
Egyptian Journal of Immunology, Jul 1, 2023
Dialysis therapy has remarkably evolved through the innovation in dialyzers and hemodialysis moda... more Dialysis therapy has remarkably evolved through the innovation in dialyzers and hemodialysis modalities, enhancing patients' quality of life. The efficacy of dialysis can be determined by measuring the reduction ratio (RR) of middle molecules, such as alpha 1-microglobulin (A1M). In this study, we tested a high-flux dialyzer, BIOPURE (Biorema) 260 HF, with a surface area (SA) of 2.6 m 2 , in terms of A1M removal and concurrent albumin loss in dialysate while receiving high-flux hemodialysis (HF-HD) and post-dilution online hemodiafiltration (OL-HDF). This crossover study comprised 25 patients who received a session of HF-HD using the BIOPURE (Biorema) 260 H, followed by a session of post-dilution OL-HDF. A washout period of 2 weeks was instilled between the two sessions, during which the patients received HF-HD using high-flux dialyzers (maximum SA 2.0 m 2). All patients' hourly dialysate albumin and pre/post dialysis concentrations of A1M were measured. The dialyzer used in this study resulted in significantly higher A1M RR of 41.9±7.93% with HDF than with HF-HD 27.12±7.65% (p<0.001), and a median cumulative dialysate albumin loss of 2.97g (IQR 1.98-3.37), and 0.67g (IQR 0.49-1.13) with HDF and HF-HD, respectively. In conclusion, the dialyzer BIOPURE (Biorema) 260 HF (SA 2.6 m 2) is efficient in eliminating A1M, especially with OL-HDF compared to HF-HD, with acceptable albumin loss in the dialysate.
Nephrology Dialysis Transplantation, Jun 1, 2023
Figure 2: Changes in ejection fraction as a result of Qa reduction in HD patients> 60 and <60 yea... more Figure 2: Changes in ejection fraction as a result of Qa reduction in HD patients> 60 and <60 years old. not differ much between the older and the younger: 0.6 l / min [95% CI 0.4; 0.8], p <0.0001. Moreover, the reduction of Qa in elderly patients led to a decrease in the ejection fraction (EF), which was not noticed in young patients-Fig. 2. Notably, in all patients of both groups the initial value of the EF was more than 55%. We believe that this can be explained by an abrupt increase in afterload against the background of a decreased compensatory heart capability in the elderly. At the same time, decrease in the EF after Qa reduction in the elderly may indirectly indicate that conventional EF in the elderly is maintained by a presence of a high-flow AVF. Evaluation of EF against this background creates a putative picture of well-being and can mask the development of heart failure with reduced EF for a long time. Conclusion: We noted a lower efficacy of Qa reduction as a method of reducing both cardio-fistula recirculation and cardiovascular risk in the elder patients compared to the younger patients on maintenance HD. Elder patients seem to require a different approach to reduce cardiovascular risk than younger patients.
Nephrology Dialysis Transplantation, May 1, 2015
Transplantation, Sep 1, 2022
Nephrology Dialysis Transplantation, Jun 1, 2023
Nephrology Dialysis Transplantation, Jun 1, 2020
Journal of Clinical Pharmacy and Therapeutics
Journal of The Egyptian Society of Nephrology and Transplantation
A patient registry is the collection of uniform data (clinical and others) to evaluate specified ... more A patient registry is the collection of uniform data (clinical and others) to evaluate specified outcomes for a population defined by a particular disease or therapy (target disease or therapy) and that serves one or more predetermined scientific, clinical, or policy purposes. Our aim is to establish a renal database for hemodialysis patients (as a first step) that would help in providing the optimal health care to improve quality of life and prolong survival. Egyptian renal data system (ERDS) was established out of the firm belief that delivering a clear picture of the incidence, prevalence, and outcomes of hemodialysis-related problems in Egypt is the needed action to identify the real magnitude of the problem. ERDS is the Egyptian national registry of nephrology patients. It was founded and is run by the Egyptian Society of Nephrology and Transplantation (ESNT), the only official Egyptian Non-Governmental Organization representing nephrologists and officially managing some issues of the nephrology specialty in Egypt. ERDS until now registers data about patients with End stage kidney disease (ESKD) on chronic hemodialysis, but the plan is to include more patient groups in the future. Two types of data were collected; data about the dialysis units as a whole and data specific to each patient. Data entered by all units were exported from the digital system as a .csv file that can be opened by Microsoft Excel. Data analysis was carried out by Microsoft Excel functions and Microsoft Power Business Intelligence. Results were represented by different sectors.
QJM: An International Journal of Medicine, 2021
Background Heart valve calcification was first described a century ago. Its pathologic features w... more Background Heart valve calcification was first described a century ago. Its pathologic features were first described by Dewitsky in 1910. Valvular heart disease is common in end-stage renal disease patients. The incidence of valvular heart disease is 5 times greater in dialysis patients than in the general population MGP plays a key role in the inhibition of tissue calcification, which was demonstrated in MGP-deficient mice Objective To detect the prevalence of cardiac valvular calcifications among end stage renal disease patients on prevalent haemodialysis and its relation to Matirx Gla protein. Patients and Methods Enrolled patients were recruited from Ain shams hospitals, divided into two groups according to the presence/absence of valvular calcifications on echocardiographic examination as follows: Group A: included patients with valvular calcifications. Group B: included patients without valvular calcifications. Results In current study, 19 (23.8%) patients showed mitral calcif...
Nephrology Dialysis Transplantation, 2020
Background and Aims Microalbuminuria is one of the early presentations of diabetic kidney disease... more Background and Aims Microalbuminuria is one of the early presentations of diabetic kidney disease that may progress to macroalbuminuria, progressive loss of glomerular filtration rate and eventually end stage renal disease. Early recognition and management of microalbuminuria can avert irreversible complications. Antihypertensive medications and antihyperlipidemic medications are medications that have been used to control diabetic nephropathy, but the reports of some side effects limited the usage of some of these drugs in diabetic patients. Pentoxifylline is an anti-inflammatory medication that have been experienced for clinical trials in diabetic patients with diabetic kidney disease. Effect of Pentoxifylline on albuminuria has been evaluated in several studies with different outcomes where a significant decrease in albuminuria in the Pentoxifylline group compared with placebo was the final conclusion. The aim of our study is the assessment of the value of Pentoxifylline addition ...
Nephrology Dialysis Transplantation, Jun 1, 2023
Major osteoporotic fracture (MOF) risk by 10 years by FRAX score. Figure 2: Demographic data of p... more Major osteoporotic fracture (MOF) risk by 10 years by FRAX score. Figure 2: Demographic data of patients with risk of facture >3%.
Nephrology Dialysis Transplantation, Jun 1, 2023
0.118 Male gender (%) 53 (60.9) 29 (58) 24 (64.9) 0.516 Caucasian ethnicity (%) 75 (86.2) 42 (84%... more 0.118 Male gender (%) 53 (60.9) 29 (58) 24 (64.9) 0.516 Caucasian ethnicity (%) 75 (86.2) 42 (84%) 33 (89.2) 0.488 eGFR, ml/min (IQR) 46 (27-76) 46 (28.5-70) 42.5 (25-71.3) 0.874 uPCR, mg/mmol (IQR) 573 (210-811) 318 (193-692) 795 (627-998) <0.001 Albumin, g/L (IQR) 33 (23-41) 40 (33-43) 23 (19.5-29.3) <0.001 Remission (%) Partial Complete 20 (23) 43 (49.4) 12 (24) 20 (40) 8 (21.6) 23 (62.2)
Nephrology Dialysis Transplantation, May 1, 2018
Cardiac surgery-associated acute kidney injury (CSA-AKI) is a frequent complication among patient... more Cardiac surgery-associated acute kidney injury (CSA-AKI) is a frequent complication among patients who suffer from heart diseases. To our knowledge,AKI affects the outcome of cardiac surgeries. Also, Selenium has important influences on renal function. Therefore, the present study was performed to investigate the effect of Selenium on the prevention of CSA-AKI.
QJM: An International Journal of Medicine, Mar 1, 2020
Introduction: The most common cause of mortality among chronic hemodialysis (HD) patients is card... more Introduction: The most common cause of mortality among chronic hemodialysis (HD) patients is cardiovascular disease. Hypervolemia is an important risk factor for hypertension and cardiovascular mortality in HD patients that include chronic volume overload and interdialytic weight gain (IDWG).IDWG affects cardiovascular morbidity and mortality Daily fluctuations in extracellular fluid volume might promote cardiac remodeling resulting in left ventricular hypertrophy (LVH) and cardiac fibrosis. Aim of the study: to assess interdialytic weight gain and (its relation to morbidity and mortality) among patients on maintenance hemodialysis. Patient and methods: 100 ESRD patients on regular hemodialysis included in study in Ain Shams University hospitals in march 2016 and followed up after one year in march 2017. Type of study: cohort study Patients were divided into two groups according to interdialytic weight gain (IDWG): Group I (high IDWG): 50 patients with Absolute weight gain 4kg or more. Or relative IDWG more than 3.5% of total body weight. Group II (low IDWG): 50 patients with absolute weight gain less than 3kg Or relative IDWG less than 3.5% of total body weight. Echocardiography (TTE) for all patients at the start of the study and followed up after one year for detecting outcomes included all-cause mortality, cardiovascular mortality, hospitalization for heart failure/volume overload, hospitalization for myocardial infarction, stroke. Results: we found that patient with high (IDWG) group II has significantly higher increase in left ventricular mass index (LVMI),inferior vena cava (IVC) diameter and significantly higher decrease in ejection fraction more than low IDWG group I. Conclusions: Patients with high IDWG group II at higher risk of increase LVMI, decrease ejection fraction, increase in interventricular septum (IVS), increase in inferior vena cava diameter more than patients of low IDWG group I and has more cardiovascular morbidity and mortality.
Journal of the Egyptian Society of Nephrology, 2020
Background Intradialytic hypertension (IDH) is a major problem affecting 5–15% of patients with e... more Background Intradialytic hypertension (IDH) is a major problem affecting 5–15% of patients with end-stage renal disease on maintenance hemodialysis (HD). We evaluated the changes of endothelin-1 (ET-1) levels during HD and its relation to IDH. Patients and methods We divided 48 stable HD patients into two groups: group I included 24 HD patients with IDH, and group II included 24 HD patients with well-controlled blood pressure (BP). Diabetic patients, patients taking angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARBs), and patients with severe infection, malignancy, or having decompensated liver cell failure were excluded from this study. For all patients, BP measurement was done before HD session and every half an hour throughout the sessions. ET-1 level was measured using enzyme-linked immunosorbent assay technique; three samples (before session, when BP rises during session, and at end of session) were taken from group I patients, and one sample was taken before the session in group II patients. Results Group I had significantly lower dry weight than group II (59.9±16 vs.71.5±11 kg) but a significantly higher ultrafiltration volume (2 vs. 1.5 l). There was a significant positive correlation between basal ET-1 and diastolic blood pressure after dialysis (r=0.51, P<0.05). In this study, basal ET-1 level had a significant moderate diagnostic performance in prediction of IDH (P< 0.001). Basal ET-1 more than or equal to 100 pg/ml had 100% specificity, 75% sensitivity, and 87.5% diagnostic accuracy in prediction of IDH, leading to suggestion that ET-1 was a significant risk factor for having IDH (P<0.05). Conclusion High ET-1 is a significant risk factor for having IDH, and basal ET-1 level had a significant moderate diagnostic performance in prediction of IDH.
The Journal of Vascular Access
Background and aim: HD patients using dialysis catheters have been associated with chronic inflam... more Background and aim: HD patients using dialysis catheters have been associated with chronic inflammatory state. In Egypt 6.6% of HD patients use catheters, of which short term catheters represent 59.6% and 40.4% with long-term catheters. In this study, we aimed to assess the effect of Taurolidine citrate and unfractionated heparin combination (Taurolock-hep500™) as a lock solution compared to unfractionated heparin alone on inflammatory markers, incidence of catheter related blood stream infections (CRBSI) and dialysis adequacy in HD patients with temporary HD catheters only, for 4 weeks duration. Methods: Sixty ESRD patients from hemodialysis units in Ain-Shams University hospitals (ASUH) at the time of catheter insertion we enrolled in our study. They were randomized into two groups: Group 1: Thirty patients received Taurolock-hep500™ as a catheter lock solution at the end of each hemodialysis session. Group 2: Thirty patients received unfractionated heparin as a catheter lock solu...
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Papers by Magdy El-Sharkawy