Intisar Al Riyami¹, Rayya Al Maskery², Yousef Al Sulimany², Ibrahim Al Zakwani¹, Issa Al Salmi³

¹Department of Pharmacy, Sultan Qaboos University Hospital, University Medical City, Seeb, Oman.

²Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Seeb, Oman.

³Department of Renal Medicine, The Royal Hospital, Muscat, Oman.

Background: Tacrolimus, the mainstay of immunosuppression post-renal transplantation, demonstrates considerable inter-individual pharmacokinetic variability. Limited data are available for Middle Eastern populations, particularly Omanis, necessitating population-specific evaluation.

Methods: A retrospective study was conducted at the Royal Hospital, Muscat (2020–2022), including 100 Omani renal transplant recipients (≥18 years) on tacrolimus for ≥6 months. Clinical, demographic, and pharmacokinetic data were analyzed using descriptive statistics.

Results: Mean patient age was 37 ± 12 years; 65% were male. Hypertension (76%), dyslipidemia (17%), and diabetes (15%) were prevalent comorbidities. The median concentration-to-dose ratio was 1.103 ng/mL/mg, with therapeutic levels reached after a mean of 59 days. At baseline, 70% were subtherapeutic, 17% supratherapeutic, and 13% therapeutic, with persistent subtherapeutic levels (70%) by the fifth assessment. Acute rejection and delayed graft function each occurred in 15%. Adverse events were common (98%), mainly electrolyte imbalance (74%), tremor/neuropathy (42%), and post-transplant diabetes (23%).

Conclusion: Omani renal transplant recipients show substantial variability in tacrolimus pharmacokinetics, frequent adverse reactions, and delayed attainment of therapeutic levels. Enhanced therapeutic drug monitoring and pharmacogenomic-guided dosing may improve outcomes.

Keywords: Immunosuppression, Pharmacokinetics, Rejection, Tacrolimus, Transplantation

Omar Issa Al-Hinai¹, Zeyana Alhadrami¹, Saja Mahmood¹

¹Department of Medicine - Renal Unit, Sultan Qaboos University Hospital, University Medical City, Seeb, Oman.

Background: Chronic kidney disease is a leading cause of death globally (Kovesdy, 2022). The primary treatments for end-stage kidney disease (ESKD) are dialysis and kidney transplantation, with the latter being the preferred option due to lower mortality and morbidity rates and cost benefits (Tonelli et al., 2011; Njamnshi et al., 2023). In Oman, ESKD incidence rose sharply from 618 patients in 2005 to 2,436 in 2022, as reported by the Ministry of Health. Oman has the lowest kidney transplantation rate in the region, mainly due to limited organ availability, with only eleven living donors and one deceased donor in 2022 (Ministry of Health, 2022a).

Aims and Objectives: This study aims to assess the knowledge and attitudes of medical staff in Oman regarding kidney donation and identify factors that negatively impact these perceptions.

Material and Methods: A cross-sectional study was conducted using a Google Forms questionnaire distributed among medical staff in Oman from September 10 to November 26, 2023. The data were analyzed using the Statistical Package for the Social Sciences and Chi-square tests, with results presented in tables and charts.

Results: Among 131 participants, 89.3% recognized kidney transplant as the best ESKD treatment, but only 41.2% felt knowledgeable about organ donation after death. Only 37.4% were aware that Oman has the lowest kidney donation rate, despite 73.3% knowing kidney transplants are performed in the country. While 79.4% would donate a kidney to a family member, only 58.8% were willing to donate after death. Key barriers included fear of kidney failure (75.4%) and surgical complications (61.5%) for living donation and family emotional trauma and body disfigurement for deceased donation. The most proposed solution to improve awareness was increased education through campaigns and lectures.

Conclusion: Although medical professionals in Oman possess substantial knowledge of kidney donation, fewer than half are well-informed about posthumous donation. There is a greater willingness for living donation compared to deceased donation, highlighting the need for improved awareness and education around kidney transplantation in the healthcare community.

Keywords: Chronic kidney disease, Health workers, Kidney donation, Kidney transplantation, Knowledge

Thurayia Al Sulaimi¹, Ghareed Al Safadi¹

¹Department of Pediatric Nephrology, Nizwa Hospital, Oman.

Thrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy (TMA) caused by severely reduced activity of ADAMTS13, leading to arteriolar platelet-rich thrombi, organ ischemia, neurologic symptoms, kidney dysfunction, thrombocytopenia, and microangiopathic hemolytic anemia. Over 90% of cases are immune-mediated due to anti-ADAMTS13 autoantibodies. Hereditary TTP (hTTP) is an ultra-rare autosomal recessive disorder from pathogenic ADAMTS13 variants, causing severe congenital enzyme deficiency. Diagnosis is often delayed due to variable or mild symptoms. The greatest risk occurs in neonates (severe hyperbilirubinemia) and during pregnancy, with other triggers including infection and vaccination. We report an 8-year-old girl admitted to the intensive pediatric care unit with a few days’ history of fever associated with mild respiratory symptoms. Her clinical examination revealed pallor and a few petechiae. Her blood pressure was high, 137/95. There were no neurological signs or symptoms. Her laboratory results showed significant thrombocytopenia (platelet count 26.2 × 109/L), elevated lactate dehydrogenase (2231U/L), low haptoglobin (<100 mg/L), and features of microangiopathic hemolytic anemia with schistocytes (~4%) on blood film [Figure 1]. She required a PRBC transfusion for severe hemolytic anemia. She suffers severe acute kidney injury with serum creatinine of 174 umol/L, hematuria, and proteinuria. She tested positive for influenza B. TMA was suspected, and further evaluation revealed ADAMTS-13 deficiency <2% with negative antibodies. Her genetic test came back positive for a homozygous pathogenic mutation in the ADAMST13 gene. A novel, not previously reported ADAMTS13 Frameshift Pathogenic Variant c.3844del p.(Val1282CysfsTer30) was identified in the whole exome sequencing of this patient. During the recovery phase, she had features of acute tubular necrosis manifested as massive polyuria, hypomagnesemia, and metabolic acidosis. Unlike immune TTP with a sudden onset, hTTP often presents mildly with non-specific, ongoing symptoms such as headache, lethargy, or abdominal discomfort. Early recognition and plasma infusion are crucial in severe cases. Our patient had an atypical presentation without neurological symptoms and recovered spontaneously with supportive care, remaining asymptomatic. Long-term management requires close monitoring and may include prophylactic recombinant ADAMTS-13 (Food and Drug Administration approved in 2023) to prevent relapse, particularly during stress periods. This case highlights the importance of considering hTTP in children presenting with TMA even in the absence of any neurological symptoms. Early diagnosis is crucial to improving outcomes and reducing morbidity.

Close

Figure 1:

(a) The black arrow points to a schistocyte. The arrowhead indicates a reticulocyte. There is also a neutrophil with a segmented nucleus visible, (b) The black arrow points to another example of a schistocyte. A nucleated red blood cell (normoblast) is also visible.

Export to PPT

Keywords: ADAMTS13, Hemolytic anemia, Hereditary thrombotic thrombocytopenic purpura, Novel mutation, Thrombocytopenia

Michael Mamdouh Soliman¹, Iman Busafi¹, Mohamed Soliman Helwa¹, Ehab A. Goda¹

¹Al Amerat Renal Dialysis Unit, The Directorate General of Health Services, Ministry of Health, Muscat, Oman.

Introduction: Tunneled central venous catheter (CVC) remains the preferred vascular access at hemodialysis initiation in developing countries despite a high burden of infection complications. The goal of this study was to determine the burden, risk factors, and microbiological spectrum of catheter-related bloodstream infections at the Renal Medical Care Center in the Sultanate of Oman.

Methods: A retrospective cohort study design was applied among patients who underwent CVC for hemodialysis between January 2023 and December In 2025, with no native arteriovenous fistula, and stayed more than 48 h. Data were collected from the patient’s registration “Shifa System,” patient charts, and microbiology registry, and analyzed using the Statistical Package for the Social Sciences 21. Binary logistic regression was applied to assess the relationship between the independent and outcome variables. P < 0.05 with adjusted odds ratio (AOR) and 95% confidence interval (CI) were used as statistically significant variables.

Results: In this study, 353 patients were included. The mean was 49 (±17.9)years. An eighty (13.4%) catheter-related bloodstream infections (CRBSIs) were documented with an incidence rate of 3.9 episodes/1000 catheter days. The causative microorganism was predominantly Gram-positive (57.6%). In the multivariable model, three variables remained independently associated with CRBSIs: Previous CVC infection, elevated white blood cell (WBC) count, and low hemoglobin level. Patients with a history of previous CVC infection had a significantly higher risk of developing CRBSIs compared to those without such a history (AOR = 11.9; 95% CI: 3.07–45; P < 0.001), indicating nearly a twelve-fold increased risk. Similarly, patients with a WBC count greater than 10,000 cells/ mm3 were more likely to develop CRBSIs than those with lower counts (AOR = 3.11; 95% CI: 1.55–6.23; P < 0.001). In addition, patients with a hemoglobin level less than 10 mg/dL had a significantly increased risk of CRBSI (AOR = 2.78; 95% CI: 1.28–6.01; P < 0.05) compared to those with levels above 10 mg/dL. Males comprised 57.5% of the study population were more likely than females to develop CRBSIs, though the association was not statistically significant (AOR = 1.22; 95% CI: 0.73–2.03). Patients with comorbidities (63.2%) had a higher likelihood of developing CRBSIs compared to those without comorbidities.

Conclusion: The incidence of catheter-related bloodstream infection among patients on hemodialysis was high, with Gram-positive predominance. Early fistula must be planned to reduce the duration of temporary vascular access.

Keywords: Catheter-related bloodstream infection, Central venous catheter, Hemodialysis, Microorganism, Risk factors

Shaimaa Daoud¹

¹Department of Renal Dialysis Unit, Al Seeb, Muscat, Oman.

Hemodialysis (HD) patients have a significantly increased risk of infective endocarditis (IE), with a poorer prognosis than the general population. The most affected sites are the mitral and aortic valves, and vascular access is often the source of infection. We report a 49-year-old woman on chronic HD who developed recurrent catheter-related bloodstream infections complicated by IE. The first episode was culture-negative IE with vegetations on the tricuspid valve and catheter tip, detected by transesophageal echocardiography. She improved with intravenous antibiotics and catheter removal. The second episode presented with fever and rigors, with positive blood cultures for Klebsiella pneumoniae (non-HACEK Gram-negative), an uncommon cause of IE in HD patients. Vegetations were noted on the mitral valve [Figure 1]. She was successfully managed with prolonged intravenous ceftriaxone without surgical intervention, given her poor cardiac function. This case highlights the importance of early suspicion of IE in HD patients presenting with bacteremia, the need for echocardiographic evaluation, and awareness of rare non-HACEK Gram-negative organisms. Optimal management requires a multidisciplinary approach.

Close

Figure 1:

Mitral valve vegetations.

Export to PPT

Keywords: Blood culture, Catheter-related bloodstream infection, Hemodialysis, Infective endocarditis, Non-HACEK Gram-negative bacteria

Abdullah Alsalmi¹, Michael Soliman², Ehab Mohammed², Hatim Alnabi³, Ahmed Alnasri³, Hamed AlShari³, Amer Al Amri³

¹Department of Renal Medicine, The Royal Hospital, Muscat, Oman.

²Al Amerat Dialysis Center, Muscat, Oman.

³Department of Nephrology, Sultan Qaboos Hospital, Salalah, Oman.

Introduction: The herpes virus is the most prevalent virus among the population worldwide. It is a highly infectious virus and can result in several complications affecting different human systems, leading to severe mortality and morbidity.

Method: The study includes kidney transplant candidates (n = 906) found to be positive for herpes simplex viruses type one or two from January 01, 2008, to December 31, 2021. The patient’s laboratory results were recorded before, during, and after the infection to assess the changes through that period. Nominal data were assessed by the Chi-square test, and the comparison between laboratories in pre-, during, and post-infection was evaluated by a paired test SAT 2 levels.

Results: During the study period, there were 906 patients with kidney transplants and positive herpes simplex virus (HSV)1/2 immunoglobulin G through serology, out of which 63 (6.9%) patients fulfilled the inclusion criteria. There were 39 males (62%) and 24 females (38%), with the majority (81%) aged between 25 and 65 years. Gastrointestinal is the most involved system in 21 (33.1%) of patients, with a presentation of mouth ulcers, and skin was affected in 6 (9.5%). Serum creatinine level and estimated glomerular filtration rate were not affected by the infection in both levels, with P-values (0.472 and 0.799), respectively.

Conclusion: The incidence of HSV infection in post-kidney transplantation was 7% with most patients having gastrointestinal tract or central nervous system manifestations. The kidney function remains reasonably stable after the viral infection treatment. Close monitoring of transplanted patients with minimal immunosuppressive drug dosages and proper follow-up with drug levels is paramount. In addition, proper education of patients is very important.

Keywords: Herpes simplex virus-1, Herpes simplex virus-2, Immunosuppression, Post-transplant infections, Seropositivity

Ahmed Atris¹, Michael Mamdouh¹, Thamreen Al Zadjali², Adham Ahmed², Hamed Al Shahri², Amer Al Amri³

¹Department of Renal Medicine, Directorate General of Health Services, Ministry, Muscat, Oman.

²Department of Renal Medicine, The Royal Hospital, Muscat, Oman.

³Department of Nephrology, Sultan Qaboos Hospital, Salalah, Oman.

Objective: The objective of the study is to evaluate whether antibiotic catheter lock prevents catheter-related bloodstream infection (CRBSI) in hemodialysis (HD) patients with recurrent CRBSI and its cost-effectiveness.

Design: Prospective case series study.

Setting: A renal dialysis center, Muscat, Ministry of Health, Sultanate of Oman.

Selection and Method: The study was started in September/2020 till August/2021 by four hemodialysis outpatients with recurrent per-catheter infections (last access options as all of them were not fit for arterio-venous fistula [AVF]/arterio-venous graft [AVG]), with recurrent hospitalization and readmission and started on an antibiotic catheter lock (vancomycin or gentamycin according to the last blood culture reports, and continued for 1 year.

Result: During 1 year of follow-up, zero incidence of per-catheter infection, hospitalization, and readmission after use of an antibiotic catheter lock, and a significant decrease in erythropoietin (EPO) dose with significant cost-effectiveness either directly or indirectly.

Conclusion: The use of an antibiotic catheter lock is highly effective in eradicating CRBSI in hemodialysis patients with recurrent CRBSI, with a significant cost-effectiveness decrease either directly through preventing infection and cost of hospitalization, or indirectly through decreased EPO dose.

Keywords: Antibiotic catheter lock, Catheter-related bloodstream infection, Cost effectiveness, Erythropoietin reduction, Gentamicin lock

Ammar Al Ali¹, Khalfan Al-Shaaili¹, Jehad Al Laham¹, Hanaa El Sayed¹, Samira Alsaeghi¹

¹Department of Nephrology, Nizwa Hospital, Oman.

Background: Secondary hyperparathyroidism remains a central challenge in the management of mineral and bone disorders among peritoneal dialysis (PD) patients. This study aimed to identify biochemical predictors of parathyroid hormone (PTH) control, assess the diagnostic value of routine markers, and evaluate compliance with Kidney Disease: Improving Global Outcomes (KDIGO) 2017 targets.

Methods: A cross-sectional study was conducted on 69 prevalent PD patients at Nizwa Hospital in 2024. Patients with PTH <15 pmol/L, prior parathyroidectomy, or <3 months on PD were excluded. Linear regression modeled log₁₀-PTH, while ROC analysis evaluated alkaline phosphatase (ALP), serum phosphate, and corrected calcium in discriminating uncontrolled PTH (>60 pmol/L). Compliance with KDIGO targets was compared across continuous ambulatory PD (CAPD), automated PD (APD), and continuous cycling PD (CCPD).

Results: Serum phosphate (β = 0.221, P = 0.033) and ALP (β < 0.001) were independent predictors of elevated PTH. ALP showed diagnostic utility (AUC = 0.709, cutoff ≥125 U/L). CAPD achieved the highest PTH control (54.3%) compared to APD and CCPD.

Conclusions: Phosphate and ALP are reliable predictors of PTH control in PD patients. An ALP threshold ≥125 U/L may serve as a practical marker of biochemical instability. CAPD demonstrated relatively better KDIGO compliance, though significant gaps persist.

Keywords: Alkaline phosphatase, Mineral and bone disorder, Peritoneal dialysis, Parathyroid hormone, Secondary hyperparathyroidism

Hamed AlShahri¹, Omaima Al Jabal¹

¹Department of Nephrology, Sultan Qaboos Hospital, Salalah, Oman.

Wound healing in diabetic patients with end-stage renal disease (ESRD) presents significant clinical challenges, particularly following surgical procedures such as arteriovenous (AV) fistula creation for hemodialysis access. Far infrared (FIR) therapy has shown potential in promoting tissue repair, though its integration into standard care remains limited. We report the case of a 63-year-old female with ESRD secondary to diabetic nephropathy who developed a non-healing wound at the AV fistula site one-month post-surgery. Due to logistical constraints preventing daily wound therapy, FIR therapy was pragmatically integrated into her thrice-weekly hemodialysis sessions, administered for 40 minutes per session. Significant clinical improvement was noted after 3 weeks, with complete wound healing achieved by the 8th week. At 6-month follow-up, the fistula remained patent with adequate dialysis efficiency and no wound recurrence. This case highlights a practical and effective approach to wound management in high-risk ESRD patients by integrating FIR therapy into routine dialysis sessions. The favorable outcome underscores the potential of FIR as an adjunctive modality when conventional daily wound care is not feasible. This report adds to the growing evidence supporting FIR therapy and may represent the first documented case of its clinical integration with dialysis workflow in Oman.

Keywords: Arteriovenous fistula, Diabetic wound, End-stage renal disease, Far infrared therapy, Wound healing

Bilal Mohsin¹

¹King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.

Background: Accurate estimation of glomerular filtration rate (GFR) is essential in evaluating kidney donors. While nuclear medicine GFR (NM GFR) remains the gold standard, serum-based estimates such as creatinine estimated glomerular filtration rate (eGFR) and cystatin C eGFR are widely used for their accessibility. This study examines the correlation between these modalities across age, gender, body mass index (BMI), and muscle mass, with NM GFR used for validation.

Methods: A retrospective review was conducted on adult kidney donors evaluated at King Faisal Specialist Hospital and Research Center, Jeddah, from January 1 to December 31, 2024. Donors were stratified by age (<25, 25–40, >40, >50 years) and BMI (<25, 25–30, >30). Creatinine eGFR was calculated using the Cockcroft–Gault equation, cystatin C eGFR through chronic kidney disease-epidemiology collaboration (EPI), and NM GFR was performed when both serum estimates were <90 mL/min/1.73 m². Pearson correlation coefficients assessed agreement across subgroups.

Results: Among 768 donors (52% male), median age was 32 years and median BMI 28.5 kg/m². In donors <25 years with BMI <25, creatinine and cystatin C eGFR showed a strong correlation (r = 0.89, P < 0.001), with a mean difference of 9.8%. In donors aged 25–40 with BMI >30, creatinine eGFR underestimated renal function by 15–25% compared to cystatin C and NM GFR (r = 0.72, P < 0.01). In donors >40 years with BMI <30, cystatin C eGFR aligned more closely with NM GFR (r = 0.81). In donors >50 years with BMI <30, all three modalities showed strong correlation (r = 0.87– 0.91), with a mean difference of 4.5–7.1%.

Conclusion: Creatinine eGFR accurately predicts renal function in younger donors with BMI <30. In other groups, cystatin C eGFR shows a stronger correlation with NM GFR. In older donors (>50 years) with BMI <30, all modalities perform comparably. We recommend age- and BMI-based stratification when selecting GFR estimation methods for kidney donor assessment.

Keywords: Cystatin C, Cockcroft-Gault equation, Donors, Glomerular filtration rate, Renal function

Zia Zargham¹, Bilal Mohsin¹, Wael Habhab¹

¹King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.

Background: Kidney transplantation is the preferred treatment for end-stage kidney disease, with living kidney donation playing a critical role in addressing the organ shortage. The long-term kidney function of donors remains a concern, particularly regarding the risk of chronic kidney disease post-donation. This study examines the predictive value of computed tomography (CT) kidney volumetry – specifically, remaining kidney volume (RKV) and cortical volume (RCV) – in relation to kidney function 1 year after donation.

Methods: We retrospectively analyzed 77 consecutive adult living kidney donors, with a follow-up duration of 1 year. Clinical and demographic data, pre- and post-donation creatinine, and estimated glomerular filtration rate (eGFR), and CT-derived RKV and RCV normalized to body surface area (BSA) were collected with follow-up of kidney function at 1, 3, 6, and 12 months. Univariate and multivariable linear regression models were evaluated associations between volumetric parameters and baseline eGFR pre-donations with 1-year eGFR post-kidney donation, adjusting for potential confounders.

Results: Donors had a median age of 29 years and were predominantly male (71%). The mean RKV/BSA and RCV/BSA were 76.8 ± 12.4 mL/m2 and 59.1 ± 11.8 mL/m2, respectively. Baseline eGFR averaged 103.5 ± 17.8 mL/min/1.73m2, dropping to 71.6 ± 15.0 mL/min/1.73m2 at 1-year post-donation. RKV/BSA and RCV/BSA showed positive correlation with 1-year eGFR, in univariate analysis, with one SD increase in RKV/BSA associated with a 4.32 units/year higher eGFR (β = 4.32, standard error [SE] = 1.66, t = 2.60, P = 0.0111) and one SD increase in RCV/BSA associated with a 3.28-unit higher eGFR (β = 3.28, SE = 1.69, t = 1.94, P = 0.0562). Donor age and BSA showed a negative correlation with 1-year e-GFR, but multivariable analysis showed baseline eGFR as the sole independent predictor of post-donation kidney function (β = 0.44, P < 0.0001).

Conclusion: The role of CT volumetry parameters should be complementary rather than central in kidney donor evaluation. Baseline kidney donor eGFR has a strong predictive value of 1-year eGFR post-kidney donation even after adjustment for other confounders. CT kidney volumetry (RKV/BSA and RCV/BSA), donor BSA, and age have limited individualized predictive value in the 1-year eGFR outcome in kidney donors. The adverse coexistence of these indicators should be carefully considered during kidney donor assessment. Future research should aim for larger, multicenter prospective trials with longer duration of follow-up.

Keywords: Computed tomography kidney volumetry, Donor outcomes, Estimated glomerular filtration rate, Remaining cortical volume, Remaining kidney volume

Bilal Mohsin¹ Eidah Al Jehani¹, Hanoof Alamoudi¹, Najla Zabani¹

¹King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.

Introduction and Aim: Human leukocyte antigen (HLA) incompatibility remains a significant challenge in kidney transplantation, especially in the background of paucity of available kidneys for donation, with exponentially rising incidence of end-stage kidney disease. This immunological obstacle is difficult to bridge and often leads to early or late graft rejection and reduced long-term graft survival. This study aims to evaluate the long-term outcomes of kidney transplant recipients who underwent desensitization protocols to overcome Immunological incompatibility at a tertiary care center.

Material and Methods: A retrospective cohort study was conducted in KFSHRC Jeddah between June 2015 and December 2023 involving 41 ABO-compatible renal transplant recipients with positive flow cross-match, preformed donor-specific antibody (DSA), and high HLA mismatch. Patients received desensitization therapy, including plasmapheresis, intravenous immunoglobulin, and rituximab, before transplantation. The primary outcomes measured were graft survival, graft failure, incidence of acute rejection, and all-cause mortality over a 10-year follow-up period.

Results: The age was between 20 and 73 years, with a follow-up duration of 1-9 years. We observed a graft survival of 85% with 15% (n = 5) incidence of graft failure. Reason for graft failure was chronic allograft nephropathy (CAN) (n = 2), chronic antibody-mediated rejection (ABMR) (n = 2), and Bk nephropathy (n = 1). There were 20 incidences of graft rejection in 16 patients – 18 ABMR and 2 T-cell mediated rejection (TCMR) who responded to therapy. Most of the rejections (n = 17) were observed in the first 1 year of transplant. Mean creatinine at 6 months, 2 years, 5 years, and plus 5-year follow-up was 86, 95, 98, and 106 umol/l, respectively. We did not observe any incidence of all-cause mortality in our patient population.

Conclusion: The study found that desensitization therapy can overcome the immunological incompatibility with favorable short and long-term patient and graft-associated outcomes. In addition, patients with lower levels of preexisting DSAs had better outcomes, highlighting the importance of early and effective desensitization. The findings underscore the need for personalized desensitization strategies and continuous monitoring of DSAs to enhance graft survival and patient quality of life. Future research should focus on optimizing desensitization protocols and exploring novel therapies to further improve outcomes for HLA-incompatible kidney transplant recipients.

Keywords: ABO incompatibility, Desensitization, Donor specific antibodies, Human leukocyte antigen, Kidney transplant

Bilal Mohsin¹, Najla Zabani¹, Arwa Aljehani¹, Wael Habhab¹

¹King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.

Background: Peritoneal dialysis (PD) is one of the home dialysis modalities that allows the patient to enjoy the comfort of home while getting the required kidney replacement therapy. However, it can be associated with clinical and technical situations that can arise at any time and need assistance. Effective communications between patients and PD nursing staff are essential to achieve treatment goals. The objective of our study is to analyze the beneficial impact of telephonic communication between patients and PD nursing staff on clinical outcomes.

Methods: This is a retrospective cohort study involving 61 adult patients who are receiving PD in KFSHRC Jeddah, from April 1, 2024, to March 31, 2025. We reviewed the frequency of telephonic communications, the nature of reported problems, their troubleshooting by the PD nursing staff, their impact on outcomes, including continuity of PD therapy, hospital presentations for PD equipment malfunction, early detection and treatment of PD peritonitis, escalating PD physician appointments, and timely emergency medical service (EMS) presentations.

Results: Among 61 patients (37 males [60.7%], 24 females [39.3%]), the mean age was 52.1 ± 8.4 years. Over a 52-week study period, patients engaged in 968 telephonic communications, with 620 (64.1%) occurring after hours and 348 (35.9%) during working hours; 621 interactions (64.2%) were through text and 347 (35.8%) through direct phone calls. The most common reason for communication was PD equipment supply or malfunction (457; 47.1%), followed by clinical complaints (227; 23.4%), requests for laboratory reviews and medication refills (130; 13.4%). These communications resulted in continuity of PD therapy (91%; n = 415) without interruption, an 86% reduction (n = 393) in hospital presentations for troubleshooting PD-associated equipment, early detection and treatment of peritonitis (mean reduction in initiation of treatment by 18 ± 5.1 h. There was an escalation of PD physician appointment by 18 ± 3.1 days (P < 0.05) and a reduction in delay in EMS presentation by 6.4 ± 2.8 h (P < 0.05).

Conclusion: Telephonic communication in the PD unit can lead to successful continuity of PD therapy. It ensures the timely initiation of required medical therapies, escalation of medical care by expediting early physician review, and EMS presentation as needed. Consequently, this leads to improved clinical outcomes, judicious and timely EMS and hospital visits, and effective resource management.

Keywords: Emergency medical service, Peritoneal dialysis, Medication refills, Troubleshooting, Telephonic communications

Bilal Mohsin¹, Najla Zabani¹, Maha Alghamdi¹, Lujain Alsayegh¹, Nasir Odah¹, Wael Habhab¹

¹King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.

Background: Patients undergoing hemodialysis, whether in-center or at home, face a high risk of hospitalization. At our center, home hemodialysis (HHD) is offered to patients with a high frailty index, multiple comorbidities, and a need for assisted mobilization. This study aimed to compare the inhospital clinical course of frail patients receiving HHD with otherwise well in-center hemodialysis (ICHD) patients.

Materials and Methods: This retrospective chart review included 42 adult patients (aged ≥18 years), with 21 patients in each group: ICHD (n = 21) and HHD (n = 21); the chart review was done from 1 August 2022 to 31 July 2023. The studied outcomes between the two groups included hospital admissions, in-hospital consultations, estimated length of stay, readmission within 30 days of discharge, and emergency medical service (EMS) presentations.

Results: Of 88 hospital admissions, 67% (n = 59) were noticed with ICHD group and 33% (n = 29) with HHD (P = 0.0014). Inpatient consultations totaled 207, with 65% (n = 135) for ICHD and 35% (n = 72) for HHD (P = 0.0000). Hospital stay duration (n = 336) was 65% (n = 218 days) for ICHD and 35% (n = 118 days) for HHD (P = 0.0000). Of the readmissions (n = 10), 80% (n = 8) occurred in the ICHD group and 20% (n = 2) in the HHD group (P = 0.06), indicating marginal significance. We noticed EMS visits (n = 41), with 78% (n = 32) for ICHD and 22% (n = 9) for HHD (P = 0.0003).

Conclusion: Despite having a higher frailty index, HHD patients demonstrated more favorable clinical outcomes across the studied parameters. A prospective multicenter study with a larger cohort and extended follow-up is required to further validate these findings.

Keywords: Clinical outcomes, Home hemodialysis, Hospitalization, In-center hemodialysis, Renal replacement therapy

Noor Al Wahaibi¹, Issa Al Salmi²

¹Oman Medical Specialty Board, Oman.

²Department of Renal Medicine, The Royal Hospital, Muscat, Oman.

Background: Chronic kidney disease (CKD) is a major public health issue associated with cardiovascular disease and early death. In recent decades, the number of cases of end-stage kidney disease has risen sharply in Oman, coinciding with better access to renal replacement therapy. Pulmonary complications can occur either directly due to renal disease (primary effects) or through systemic processes that affect both organ systems at the same time.

Objective: The objective of the study is to assess the prevalence and features of respiratory complications in CKD patients at the Royal Hospital, including demographic data, clinical presentation, laboratory results, and radiological findings.

Design: Clinical observational study approved by the Research Committee, Ministry of Health.

Methods: The study included 720 patients followed in nephrology clinics over the past 5 years. Of these, 249 developed respiratory complications. The diagnosis of respiratory complications was based on (1) clinical manifestations and (2) radiologic investigation. Initial data analysis focused on patients with respiratory complications to assess demographics, clinical presentations, laboratory results, and radiologic findings. The patients were divided into two equal groups of 249 each – those with and without respiratory complications – to identify potential risk factors. STATA software was used. Data were described as frequencies and percentages for categorical variables. Continuous variables were reported as medians and ranges or as means and standard deviations.

Results: The prevalence of respiratory complications in patients with CKD is 34.49%. The mean age of the patients was 50 ± 18 years. The majority were males (53%), and females accounted for 46.9% of the population. Most patients (64%) were from Muscat. One-fifth of the patients (22%) were receiving dialysis. Based on radiological findings, the most common respiratory complication was pulmonary edema (50.2%). It was followed by pleural effusion (45.78%) and, less commonly, chest infection (40.96%). A more advanced CKD stage was associated with an increased prevalence of respiratory complications (P = 0.001), with 100% of patients with CKD stage V developing a respiratory complication. Comparing CKD patients who developed respiratory complications with those who did not, it was found that they were significantly more likely to be diabetic (P = 0.008) and to have established ischemic heart disease (P = 0.0001). Echocardiography showed that patients with respiratory complications had significantly lower ejection fractions (P = 0.001), and diastolic dysfunction was more prevalent (P = 0.002).

Conclusion: Respiratory complications occur in approximately one-third of CKD cases, with pulmonary edema being the most common issue. Advanced CKD stages, diabetes mellitus, and ischemic heart disease increase the risk of developing respiratory problems. Since these complications pose a high risk of morbidity and mortality in CKD patients, physicians need to recognize the most common issues to provide effective, patient-centered care.

Keywords: Chronic kidney disease, Diastolic dysfunction, Low ejection fractions Pulmonary edema, Respiratory complications

Hamad Jeelani¹, Amer Said Alamri¹, Dalia Moussa¹, Arasu Mohan¹, Ahmed Hassan¹, Peter Yousef¹, Ibrahim Hamdi¹

¹Department of Nephrology, Sultan Qaboos Hospital, Salalah, Oman.

Background: The presence of pulmonary hypertension (PH) in chronic kidney disease (CKD) patients is associated with increased mortality. The presence of diabetes is associated with a higher risk of PH in CKD patients. In this study, we aimed to study the prevalence and risk factors of PH in type 2 diabetes mellitus (T2DM) with diabetic kidney disease (DKD).

Material and methods: We retrospectively analyzed 198 T2DM patients with DKD from 2017 to 2020. Complete clinical records of these patients were studied. Echocardiography was done in all patients, and PH was defined as pulmonary artery systolic pressure >35 mmHg. The prevalence of PH in DKD patients was analyzed, and the association of various risk factors was evaluated by a logistic regression method.

Results: The overall prevalence of PH was 45.5% (90 patients) with 22.2% having mild PH, 17.17% and 10.1% having moderate and severe PH, respectively. The prevalence of PH increased with CKD stage 1 having 22.8% prevalence and stage 5 CKD having 69.6% prevalence. The prevalence of PH in dialysis patients was 70.8%. PH was significantly more prevalent in dialysis patients compared to non-dialysis patients. Estimated glomerular filtration rate, higher body mass index, lower hemoglobin, proteinuria, and hyperparathyroidism were risk factors for PH in DKD patients.

Conclusion: The prevalence of PH increases with the stage of CKD in diabetic patients, with a higher prevalence in dialysis patients. Obesity, anemia, higher body mass index, proteinuria, and hyperparathyroidism predict the prevalence of PH in DKD patients.

Keywords: Chronic kidney disease, Diabetic kidney disease, Dialysis, Prevalence, Pulmonary hypertension

Ahmed Atris¹, Shaimaa Dawoud¹

¹Department of Renal Medicine, ALSEEB Renal Center, Muscat, Oman.

Background: Volume overload is a common and challenging complication in hemodialysis patients, particularly those with ascites. Traditional methods of volume assessment are limited, and accurate evaluation of venous congestion is critical for guiding fluid management. The venous excess ultrasound (VExUS) score integrates Doppler assessment of the inferior vena cava and hepatic, portal, and intrarenal veins, offering a non-invasive tool for evaluating systemic venous congestion.

Methods: We report four cases of hemodialysis patients with clinically significant ascites who underwent serial VExUS assessments. Ultrasound examinations were performed before and after hemodialysis sessions to evaluate changes in venous congestion and correlate them with ultrafiltration volumes, weight change, and ascites severity.

Results: Patient 1: Pre-dialysis VExUS grade 3, with hepatofugal portal flow; post-dialysis VExUS grade improved to 1, with corresponding decrease in body weight of 2.5 kg and subjective improvement in abdominal distension. Patient 2: Pre-dialysis grade 2 congestion, with a blunted hepatic vein waveform; after ultrafiltration, VExUS grade reduced to 1, with modest ascites regression. Patient 3: Baseline grade 3 VExUS with continuous intrarenal vein flow; post-dialysis, VExUS decreased to grade 2. Patient 4: Pre-dialysis VExUS grade 1, minimal congestion; serial assessments showed stable findings despite ultrafiltration.

Conclusions: Serial VExUS assessment provides a dynamic, non-invasive method to monitor venous congestion in hemodialysis patients with ascites. Improvement in VExUS scores corresponded with ultrafiltration and symptomatic relief, highlighting its potential role in individualized fluid management.

Keywords: Ascites, Hemodialysis, Ultrafiltration, Venous congestion, Venous excess ultrasound

Ahmed Atris¹, Abdulla Al Hassan¹, Mahmoud Al Harasi¹, Ali Al Khumisi¹, Samia Al Nabi¹

¹Department of Renal Medicine, ALSEEB Renal Center, Muscat, Oman.

Background: Hemodialysis is the most common treatment method in Oman for individuals requiring renal replacement therapy. From previous literature, it is known that the residual kidney function (RKF) in these patients has many advantages for their overall health outcomes compared to those who have lost RKF.

Aim: This is a cohort retrospective study comparing hemodialysis patients with RKF on incremental dialysis twice/week and others who lost RKF on dialysis thrice/week regarding epidemiology, clinical, laboratory, and outcomes.

Method: From January 2025 to July 2025, data were collected for analysis (26 patients in the study group and 26 patients in the control group). Clinical data and examination, by a multidisciplinary team, were carried out for all patients included, including vascular access type and duration. Laboratory investigations and quality of life include frequent visits to the emergency department, hospitalization, readmission, and long-term use of hemodialysis.

Results: A total of 26 patients were included in the study group with RKF on hemodialysis twice/week, and 26 in the control group without RKF on hemodialysis thrice/week. The two groups were comparable in age and gender distribution (P > 0.05). Patients with RKF had a significantly shorter dialysis vintage (7.6 ± 2.4 vs. 9.7 ± 3.1 years, P = 0.04). Mean urine output was markedly higher in the RKF group (700 ± 120 mL/24 h vs. <100 mL/24 h, P < 0.001). Dialysis adequacy, assessed by urea reduction ratio, was better in the RKF group (68.4% vs. 65.0%, P = 0.03). Nutritional and biochemical parameters were also more favorable in patients with RKF, including higher serum albumin (40 ± 3.2 vs. 37 ± 2.8 g/L, P = 0.02), higher calcium (2.3 ± 0.2 vs. 2.1 ± 0.3 mmol/L, P = 0.04), lower phosphorus (1.3 ± 0.2 vs. 1.7 ± 0.3 mmol/L, P = 0.01), and lower parathyroid hormone levels (60 ± 12 vs. 88 ± 15 pg/mL, P = 0.02). Hemoglobin was significantly higher in the RKF group (11 ± 0.6 vs. 10 ± 0.5 g/dL, P = 0.01). Importantly, patients with RKF had fewer emergency room visits and hospitalizations per year (11 vs.19 and 10 vs.17).

Conclusions: The extended preservation of RKF in hemodialysis patients is crucial for improving survival, dialysis adequacy, biochemical control, and overall quality of life. Clinical strategies that aim to maintain RKF, including individualized dialysis prescriptions and careful volume management, should be emphasized in routine practice.

Keywords: Preservation, Dialysis adequacy, Dialysis complications, Incremental dialysis, Residual kidney function

Ahmed Atris¹, Shaimaa Dawood¹, Fatma Alshikili¹, Badar Al Rahbi¹, Haifa Al Hassani¹, Afrah Al Gharbi¹

¹Department of Renal Medicine, ALSEEB Renal Center, Muscat, Oman.

*Corresponding author: Ahmed Atris, The Department of Renal Medicine, ALSEEB Renal Center, Muscat, Oman. ahmedatris97@gmail.com

Background: Individualized patient care in hemodialysis is essential to optimize outcomes, particularly for those with significant cardiac comorbidities. Patients at very high or high cardiac risk require tailored dialysis prescriptions. Strategies such as slower ultrafiltration rates, cooler dialysate temperature, frequent blood pressure monitoring, and use of biocompatible membranes can reduce hemodynamic stress.

Aim: Continuous cardiac monitoring and early recognition of warning signs enable timely interventions – close collaboration between nephrologists, dialysis staff, and cardiologists.

Methods: This prospective observational study included 50 hemodialysis patients stratified by cardiac risk: 34 patients categorized as very high risk (severe left ventricular dysfunction, prior cardiac arrest, or advanced ischemic heart disease) and 16 patients as high risk (ischemic heart disease, left ventricular hypertrophy, or prior arrhythmia). All patients underwent individualized hemodialysis prescriptions with special modifications: vital signs monitoring: blood pressure, heart rate, and oxygen saturation measured every 15–30 min during the dialysis session; dialysate temperature: set at 35°C to reduce intradialytic hypotension and myocardial stress; ultrafiltration rate: limited to <10 mL/kg/h to minimize hemodynamic instability; and follow-up period: 6 months.

Results: Summary (n = 50); sex: males 32, females 18; age: mean 63.4; median 65.0; range 34–85; any intervention recorded: 28. Top disease groups: ischemic heart disease (IHD) (33), heart failure (HF)/dilated cardiomyopathy (DCM) (3), IHD + atrial fibrillation (AF) (3), IHD + myocardial infarction (2), IHD + HF (2), IHD + low ejection fraction (2), AF + DCM (2), AF (1), Severe tricuspid regurgitation (1), post-cardiac arrest (1), most common intervention components: percutaneous coronary intervention (13), Coronary angiogram (9), Coronary artery bypass graft (9), Mitral valve repair/replacement (1). Over a 6-month follow-up, there was a reduction in intradialytic hypotension episodes in both groups. Lower incidence of arrhythmias, particularly atrial fibrillation and ventricular ectopy, in the very high-risk group. Fewer hospitalizations related to cardiovascular decompensation. No sudden cardiac death events were recorded during the study. High compliance with the dialysis prescription and good tolerance of cooler dialysate were reported.

Conclusion: Individualized hemodialysis prescriptions with strict cardiac monitoring, cooler dialysate, and ultrafiltration limits significantly improved tolerance and clinical outcomes in high and very-high-risk cardiac patients. This approach was associated with fewer arrhythmias, reduced hospitalizations, and no sudden cardiac deaths over 6 months. The integration of such protocols in routine dialysis care may enhance survival and quality of life for this vulnerable population.

Keywords: Atrial fibrillation, Dilated cardiomyopathy, Hemodialysis cardiac map, Individualized patient care, Ischemic heart disease

Tariq Ahmed Zayan¹, Heba Abouelyazied Khafagy¹

¹Department of Nephrology, Sur Hospital, Ministry of Health, Sur, Oman.

Background: Chronic kidney disease (CKD) affects more than 800 million individuals globally, with anemia present in up to 90% of end-stage renal disease patients. Dysregulated iron metabolism, driven by elevated hepcidin, results in functional iron deficiency. Recent insights highlight ferroptosis, an iron-dependent form of cell death, as a novel mechanism contributing to CKD progression.

Methods: We conducted a systematic review and meta-analysis of 30 studies (15 randomized controlled trials, 10 cohort, and 5 case-control) involving 5,842 adult CKD patients, including non-dialysis populations. Interventions analyzed were intravenous iron, oral iron, erythropoiesis-stimulating agents (ESAs), and hypoxia-inducible factor prolyl hydroxylase (HIF-PH) inhibitors. Outcomes included hemoglobin change, estimated glomerular filtration rate decline, iron markers, and ferroptosis biomarkers (GPX4, MDA).

Results: All therapies improved hemoglobin (mean +1.23 g/dL), though effects on renal function varied. IV iron provided superior anemia correction but increased lipid peroxidation (MDA), while HIF-PH inhibitors preserved kidney function by enhancing GPX4 activity. Machine learning identified three patient phenotypes – iron-responsive, HIF-responsive, and ESA-resistant – highlighting treatment heterogeneity.

Conclusion: This study integrates mechanistic and clinical evidence, underscoring ferroptosis as a key pathway in CKD. Personalized, biomarker-guided therapy may optimize anemia management while mitigating kidney damage.

Keywords: Anemia, Biomarker guided therapy, Chronic kidney disease, Ferroptosis, Iron metabolism

Fady Elias¹, Yaqoob Al Maimani¹, Abullah Abou Shakra¹, Said Al Mazrooei¹, Rayya Al Abrawi¹, Khalsa Al Busaidi¹

¹Bousher Dialysis Center, Muscat, Oman.

Objectives: Muscat Governorate hosts three main hemodialysis (HD) centers—Bousher, Seeb, and Amerat, collectively serving about 25% of Oman’s end-stage kidney disease (ESKD) patients on regular HD. This analysis aims to assess service delivery, clinical outcomes, laboratory results, and key performance indicators in 2024.

Material and Methods: Data were extracted from clinical records, quality audit reports, and incident reporting systems across the three centers. Indicators evaluated included vascular access, infection rates, dialysis adequacy, comorbidities, complications, laboratory targets, training, and service continuity.

Results: The analysis included 746 patients on regular HD. The number of operating HD machines was 125. The average percentage of patients with functioning arteriovenous (AV) fistulas was 69%. Collaborative efforts with Royal and Khawla hospitals have contributed to increased AVF/AVG creation and a reduction in tunneled catheter use, although catheter-related bloodstream infections remain a key challenge. Diabetes mellitus was the leading cause of ESKD, with 52% of patients having diabetes. Cardiovascular referrals and admissions averaged 8.8%, with the highest in Bousher, (10.2%) and lowest in Amerat center (6.6%) shown in Figure 1. Dialysis adequacy, as defined by a minimum Kt/V of 1.2, was consistently achieved in about 80% of the total patients.

Close

Figure 1:

References for hospital admission due to cardiac events.

Export to PPT

The percentage of patients with secondary hyperparathyroidism has been analyzed based on quarterly assessments [Figure 2]. The prevalence of anemia, defined as Hb <10 g/dl, was 19%. Other parameters that were assessed included mineral bone disorder monitoring, infection rates, staff development, vaccination protocols, and other parameters. All centers promoted BLS and ACLS certification to manage cardiovascular emergencies. Incident reporting had been analyzed as well, aiming at improving patient care.

Close

Figure 2:

Median percentage of patients with hyperparathyroidism, defined as 9 times or higher than the maximum lab reference.

Export to PPT

Conclusion: This analysis highlights the essential clinical and laboratory indicators that reflect the quality and effectiveness of hemodialysis care in Muscat Governorate. These indicators—ranging from vascular access type and dialysis adequacy to anemia management, mineral bone disorder control, and infection rates—provide a comprehensive framework for evaluating the performance of HD services. By systematically tracking and analyzing these measures, the dialysis centers can identify strengths and areas requiring intervention, enabling targeted quality improvement. This approach not only supports better clinical outcomes for patients but also establishes a practical, data-driven guide for ongoing monitoring and service development across the whole country.

Keywords: Anemia, Dialysis indicators, Hemodialysis, Hyperparathyroidism, Vascular access

K Abugrain¹, Naima AL Alawi², Badria Al Gaithi³

¹Department of Pediatric, Sultan Qaboos Hospital, Salalah, Oman.

²Department of Pathology, The Royal Hospital, Muscat, Oman.

³Department of Child Health, The Royal Hospital, Muscat, Oman.

Nephrotic–nephritic syndrome is an uncommon presentation in children, with overlapping clinical features that challenge diagnostic and therapeutic approaches. We present a rare pediatric case of secondary focal segmental glomerulosclerosis (FSGS) with distinctive immunopathological findings. A 12-year-old previously healthy girl presented with gross hematuria, oliguria, and generalized edema. Laboratory investigations showed nephrotic-range proteinuria, hypalbuminemia, hyperlipidemia, and mild acute kidney injury (KDIGO stage 1–2). Complement levels (C3, C4), anti-streptolysin O titer, and infectious and autoimmune workup (hepatitis panel, HIV, ANA, anti-dsDNA, ANCA) were all normal or negative. Supportive treatment with albumin and loop diuretics did not resolve proteinuria or hematuria, prompting renal biopsy. Histopathology revealed secondary FSGS with immunoglobulin G “podocyte dusting”, mild tubular injury, and mild interstitial inflammation. This dusting pattern, indicative of podocyte injury, has been linked in prior studies to antibodies targeting nephrin, suggesting a potential antibody-mediated podocytopathy or circulating permeability factor. The electron microscopy result is awaited to further define ultrastructural changes. The patient received pulse methylprednisolone followed by oral prednisolone, alongside lisinopril and supportive measures (calcium, vitamin D, proton pump inhibitors). She showed rapid clinical improvement with complete resolution of edema, normalization of serum albumin, clearance of gross hematuria, and a significant reduction in proteinuria, though not yet fully normalized. A focused literature search identified multiple reports of punctate IgG deposits over podocyte cell bodies (“podocyte dusting”) in patients across the MCD–FSGS spectrum, and several case series have correlated this IF pattern with circulating anti-nephrin antibodies. In severe or fulminant presentations, authors describe multimodal therapy including high-dose glucocorticoids, rituximab, plasmapheresis, and, when indicated, temporary dialysis; in some reports, combined regimens (plasmapheresis, rituximab, and mycophenolate) were required to achieve antibody clearance and remission. Conversely, milder cases have responded to corticosteroid monotherapy with gradual proteinuria reduction. Our index patient exhibited non-severe disease and achieved a favorable response to glucocorticoids alone, avoiding escalation to extracorporeal or B-cell–directed therapies. This case highlights an unusual presentation of secondary FSGS with nephrotic–nephritic features in a child without an identifiable systemic or infectious cause. The presence of immunoglobulin podocyte dusting suggests a possible immune-mediated mechanism involving anti-nephrin antibodies. Recognition of such unique histopathological patterns may have implications for diagnosis, prognosis, and targeted immunotherapy in pediatric glomerular disease. Ongoing follow-up and advanced microscopy will be critical to elucidating the underlying pathophysiology and guiding long-term care.

Keywords: Anti-nephrin antibodies, B-cell directed-therapies, Focal segmental glomerulosclerosis, Plasmapheresis, Podocytopathy

Fatima Alkindi¹, Ahmad Chaaban², Mohamad Al Hakim², ArifAlam³, Aydah Al-Awadhi³, Sarah Jamil¹, Shaima Al Kaabi¹, Maitha Al Blooshi¹,

Mohammed Budruddin², Imran Khan², Yousef Boobes²

¹Department of Internal Medicine, SEHA - Tawam Hospital, Al Ain, United Arab Emirates.

²Department of Nephrology, SEHA - Tawam Hospital, Al Ain, United Arab Emirates.

³Department of Oncology, SEHA - Tawam Hospital, Al Ain, United Arab Emirates.

Objectives: Cancer poses a significant risk to patients undergoing hemodialysis or kidney transplantation (KT), contributing to high mortality rates. This study aims to evaluate the clinical outcomes of cancer in KT and dialysis patients treated at a tertiary oncology center in the UAE.

Material and Methods: A retrospective cohort study was conducted at Tawam Hospital from January 2009 to 2020. Adult KT recipients and hemodialysis patients diagnosed with cancer post-transplant or post-dialysis initiation were included. Data on cancer types, treatment modalities, and mortality were analyzed descriptively.

Results: Among 528 KT recipients, 26 (4.9%) developed cancer, with a mean age of 54.6 years. Hematological malignancies, primarily post-transplant lymphoproliferative disorder (PTLD), accounted for 27%. Nonhematological cancers included GI, breast, skin, and thyroid malignancies. Over half had metastatic disease; 42% died. Of 1708 dialysis patients, 68 (3.9%) developed cancer, mean age of 68.8 years. Urogenital, GI, and hematological cancers were most common. Metastatic disease was present in 33.8%, and mortality reached 73.5%.

Conclusion: Cancer prevalence in KT and dialysis patients was 4.9% and 3.9%, respectively. Hematological cancers dominated in KT patients, while urogenital and GI cancers were more frequent in dialysis patients. High rates of metastasis and mortality highlight the need for targeted screening and management strategies.

Keywords: Hemodialysis, Kidney transplantation, Lymphoproliferative disorder, Metastasis, Post-transplant malignancy

Fatima Alkindi¹, Mohamad Al Hakim³, Ahmad Chaaban², Mohammed Budruddin³, Imran Khan³, Abraham George³, Yousef Boobes²

¹Department of Internal Medicine, Sheikh Tahnoon Bin Mohammed Medical City and Tawam Hospital, SEHA, PureHealth, Al Ain,

²Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University,

³Department of Nephrology, SEHA Kidney Care, SEHA, PureHealth, Al Ain, United Arab Emirates.

Objectives: Metformin is widely used in type 2 diabetes for glycemic control and reduction of complications. However, metformin-associated lactic acidosis (MALA), though rare, poses serious risks, especially in patients with advanced chronic kidney disease (CKD) or acute kidney injury (AKI). This study describes the clinical outcomes of diabetic patients with severe MALA and AKI managed with dialysis.

Material and Methods: A retrospective chart review was conducted at Tawam Hospital from January 2020 to 2024. Diabetic patients diagnosed with MALA and AKI who required dialysis were included. Clinical presentations, laboratory findings, treatment modalities, and outcomes were analyzed descriptively.

Results: Six patients (mean age 59 years; equal gender distribution) with type 2 diabetes and CKD stages I–IIIA were studied. All were on metformin, with additional antihypertensives and antidiabetic agents. Presenting symptoms included fatigue, vomiting, dyspnea, and altered mental status. Lab results showed severe metabolic acidosis (mean pH 7.09), elevated lactate (11.8 mmol/L), and AKI stage 3 (mean creatinine 705 μmol/L). Five patients received hemodialysis; one required continuous renal replacement therapy. Complications included sepsis (66.6%), respiratory failure (33.3%), and arrhythmia (33.3%). Renal recovery occurred in five patients; no mortality was observed.

Conclusion: MALA is a rare but reversible condition. Early recognition and dialysis can lead to favorable outcomes, especially in diabetic patients with AKI and concurrent angiotensin-converting enzyme inhibitors (ACEI)/ angiotensin receptor blockers (ARB) use.

Keywords: Acute kidney injury, Hemodialysis, Metformin-associated lactic acidosis, Renal replacement therapy, Type 2 diabetes mellitus