Mucocutaneous Manifestations in Kidney Transplant Patients: Risk Factors.

Introduction Mucocutaneous complications in kidney transplant patients are due to drug toxicity or immunosuppression. The main objective of our study was to determine the risk factors associated with their occurrence. Methods We conducted a prospective analytical study (January 2020- June 2021) including kidney transplant patients seen at the Nephrology Department. We described the characteristics of the patients who presented mucocutaneous complications and then compared them to those who didn't to deduce the risk factors. Statistical analysis was performed using SPSS 20.0 (p<0.05). Results Of the 86 patients recruited, thirty patients had mucocutaneous complications. The mean age was 42.73, with a male predominance (73%). Ten kidney transplants were performed from a living-related donor. All the patients received corticosteroids, Mycophenolate Mofetil, and the Calcineurin Inhibitor: Tacrolimus (76.7%) or Ciclosporin (23.3%). Induction was performed with Thymoglobulin (n=20) or Basiliximab (n=10). Mucocutaneous complications were dominated by infectious manifestations (53.4%): eight cases of fungal infections; six cases of viral infections: warts (n=3), herpes labialis (n=2), intercostal herpes zoster (n=1), and two cases of bacterial infections: atypical mycobacteria and boils. Inflammatory complications (36.6%) included acne (n=4), urticaria (n=3), rosacea (n=1), simple maculopapular exanthema (n=1), aphthous lesion (n=1), and black hairy tongue (n=1). Actinic keratosis, skin xerosis, and bruises were found in one patient respectively. The evolution with a symptomatic treatment was good in all the patients. After statistical analysis, the factors significantly associated with the occurrence of mucocutaneous complications were advanced age, male gender, anemia, HLA non-identical donor, as well as the use of Tacrolimus or Thymoglobulin. Conclusion Infectious mucocutaneous complications are the most common dermatological manifestations among renal transplant recipients. Their occurrence is related to advanced age, male gender, anemia, HLA non-identical donor, and the use of Tacrolimus or Thymoglobulin.

COVID-19: Patient care after discharge from the Intensive Care Unit.

INTRODUCTION: The Ibn Rochd CHU is a tertiary care structure that provides care for the most severe cases of COVID-19 requiring hospitalisation in intensive care. The objective of study is to describe the complementary medical and psychological care of patients with COVID-19 in the endocrinology department after a stay in intensive care. PATIENTS AND METHODS: This is a descriptive observational study of patients transferred from the intensive care unit to the endocrinology service following a COVID-19 infection during the period from 17 April 2020 to May 26, 2020. Clinical characteristics of the patients and complications related to COVID-19 infection were studied; a nutritional assessment using the MNA nutritional status assessment questionnaire; psychological assessment using quality-of-life questionnaires (Hamilton depression and anxiety, HAD, SF36, PCLS); a treatment satisfaction questionnaire (TQCMII) and an assessment of patient autonomy by the ADL score. RESULT: Our study included 41 patients with an average age of 55 years (19-85 years), a sex ratio M/F of 1.05, 43.9% were diabetic, 34.1% hypertensive, 4.9% asthmatic and 5% obese, and 51.2% were severe and critical cases. The average ICU stay is 8.42 days, requiring intubation in 12.2% of cases. All patients were treated with the Hydroxychloroquine, Azithromycin, vitamin C, zinc and corticosteroid protocol, 14.6% had undernutrition and 65.9% had a risk of undernutrition. The average BMI was 25.34 kg/m2 (17-42), 61% had experienced weight loss, which was greater than 8 kg in 26.1% of cases, 12.2% of patients were not autonomous, 12.2% had moderate depression, 2.4% severe depression, 14.6% mild to moderate anxiety, 12.2% severe anxiety and 29.3% suffered acute post-traumatic stress disorder. CONCLUSION: Patients with COVID-19 are, in addition to the complications from coronavirus infection, vulnerable to undernutrition, psychological and motor complications. Additional care before discharge is essential for better integration of patients into their families.

Nutritional status assessment in patients with Covid-19 after discharge from the intensive care unit.

INTRODUCTION: The nutritional diagnosis and early nutritional management of COVID-19 patients must be integrated into the overall therapeutic strategy. The aim of our study is to assess the nutritional status of patients with COVID-19 after a stay in intensive care, to describe the prevalence of undernutrition, to determine the factors influencing undernutrition and to describe the nutritional management. TOOLS AND METHODS: This is a descriptive observational study of adult patients admitted to the endocrinology service for additional care after a stay in intensive care during the period from April 17, 2020 to May 26, 2020. The assessment tool used was the Mini Nutritional Assessment (MNA). RESULTS: Our study included 41 patients; the average age of the patients was 55 years, 51.2% had a severe or critical form of COVID-19, 75.6% stayed in intensive care, 12.2% had a loss of autonomy. The average BMI was 25.2 kg/m2 (17-42 kg/m2), 42.5% were overweight, 61% had weight loss, 26.2% had weight loss greater than 10%, 14.6% of our patients were undernourished, 65.9% were at risk of undernutrition, 19.5% had hypoalbuminemia, 17.1% had hypoprotidemia, 19.5% hypocalcemia, 34.1% anemia, 12.2% hypomagnesemia and 51.2% had a deficiency in vitamin D. A positive correlation was found between poor nutritional status and a longer stay in intensive care (>5 days) (p = 0.011) and lymphopenia (p = 0,02). CONCLUSION: Despite a personalized diet, 14.6% of patients presented undernutrition. Particular attention should be paid to patients with a long stay in intensive care.

Epidemiological Study of Acute Kidney Injury in Intensive Care Unit: Evolution and Prognosis.

Acute kidney injury (AKI) is very common in intensive care units (ICUs). Its complications are often fatal, life-threatening, and may lead to kidney impairment. This is a multicentric, prospective, and descriptive study, spread over a period of six months, from January 1, 2017 to June 30, 2017, including incident cases of AKI defined according to the AKI Network criteria seen in the ICUs of Ibn Rochd University Hospital of Casablanca. Their evolution was studied during the hospital stay at three, six, 12, and 24 months. A total of 102 patients were included, 52% of whom were female. The median age was 45.2 ±0 22.93 years (10 days-87 years). Clinically, 28.4% were oligo-anuric and 54.8% had a multivisceral failure, mainly neurological and respiratory. The median creatinine level was 37.6 mg/L ± 19.82 (8-230). AKI was mainly organic and functional in 43.1% and 40.2% of cases, respectively, and the main etiologies were dehydration, sepsis, and tumor obstruction. Dialysis was required in 25.5% of cases. When discharged from the hospital, mortality occurs in 35% of cases, total recovery of renal function was observed in 22%, progression to chronicity in 38%, and end-stage renal disease (ESRD) in 5% of cases. The progression to chronicity and ESRD increased in the 1st and 2nd year of followup after the first episode of AKI. The risk factors for progression to chronicity were as follows: age, hypertension, the presence of comorbidities, the presence of multivisceral failure and the severity of AKI. AKI is now considered a risk factor for chronic kidney disease and longterm mortality, hence the interest and importance of nephrological monitoring.

Carbon footprint of a hemodialysis unit in Morocco.

Climate changes have a major influence on the overall health of the population. They are directly linked to the emissions of the greenhouse gases (GHG). The extent of GHG emission in relation to hemodialysis has been measured by several studies all over the world. Up to this date, no similar study has been conducted in Morocco. Therefore, the objective of our study is to conduct a review of the GHG emissions and to evaluate its specificities in order to establish a targeted action plan to reduce the ecological impact of hemodialysis in Morocco. To do this, we sought the help of a certified audit firm. Carbon Footprint tool (L'outil Bilan Carbon), established in Morocco in collaboration with Mohammed VI Foundation for the Protection of the Environment, was used to analyze the results collected for the year 2019. Our unit (conventional hemodialysis 3 × 4 hours, 424 m2 , 24 generators, 80 patients, and 29 nursing staff) generates 408.98 tonnes of CO2 equivalent per year (t CO2-eq per year) or 5.11 TeqCO2 per patient per year. The largest contributors to GHG emissions are electrical energy consumption (28%), equipment purchase and services (27%), and staff and patients travel (22%). The use of renewable energy for the operation of hemodialysis centers can be a realistic solution to reduce the ecological impact of this type of healthcare in Morocco.

Continuous venous hemodialysis integrated to the ECMO circuit in critically ill patient with COVID-19, a case report in Morocco.

Novel coronavirus 2019 (COVID-19) is a severe respiratory infection leading to acute respiratory distress syndrome [ARDS] accounting for thousands of cases and deaths across the world. Several alternatives in treatment options have been assessed and used in this patient population. However, when mechanical ventilation and prone positioning are unsuccessful, venovenous extracorporeal membrane oxygenation [VV-ECMO] may be used. We present a case of a 62-year-old female, diabetic, admitted to the intensive care unit with fever, flu-like symptoms and a positive COVID-19 test. Ultimately, she worsened on mechanical ventilation and prone positioning and required VV-ECMO. The use of VV-ECMO in COVID-19 infected patients is still controversial. While some studies have shown a high mortality rate despite aggressive treatment, such as in our case, the lack of large sample size studies and treatment alternatives places healthcare providers against a wall without options in patients with severe refractory ARDS due to COVID-19.

Management of pain at arteriovenous fistula puncture: Cryotherapy versus lidocaine/prilocaine.

Pain at arteriovenous fistula (AVF) puncture is common in hemodialysis (HD) patients. The purpose of our work is to determine its frequency, to evaluate the efficiency of two techniques: anesthetic cream (Emla™) and cryotherapy, and to compare their efficiency. A prospective and interventional analytical study of HD patients was conducted in our structure. We included all patients with pain at AVF puncture. We evaluated the pain intensity using a visual analogue scale before and after our intervention: Emla™ cream during three consecutive HD sessions, then cryotherapy (ice cubes placed in latex gloves, during 5 min, directly applied on the puncture sites) during three consecutive HD sessions. The statistical analysis was performed using the Epi Info software. Eighty-four patients are undergoing HD in our structure, of which 32 (38%) report pain at AVF puncture. The mean value of the visual analog scale before the puncture was 7.19 ± 1.95 (4-10). Pain decrease was statistically significant for both techniques. Comparative analysis of the two techniques revealed a significant reduction in pain in favor of cryotherapy (P 0.001). The analgesic effect has been proved for both techniques. Cryotherapy provides higher efficiency, with fewer constraints, and could be proposed for the management of pain at AVF puncture.

An unorthodox pathophysiology of severe cases of COVID-19 the weak heme hypothesis.

Important amount of severe cases is the main concern in COVID-19 pandemic. It could be the running cause of the burn out of the health system in many countries. The aim of this paper is to suggest a pathophysiologic hypothesis to explain the main characteristics of severe cases of COVID-19 and its underlying conditions. In fact, the clinical and biological picture of severe cases of COVID-19 can easily be explained by free heme toxicity exceeding the endogenous antioxidant systems. Severe cases of COVID-19 are comparable to acute porphyria. On the other hand, the geographical distribution of severe cases of COVID-19 is directly associated to how fresh or polluted the air is. Finally, the relatively low rate of severe cases of COVID-19 could be explained by the presence of an unstable hemoglobin variant highly sensitive to the intrinsic conditions resulting from the acute pneumonia secondary to SARS-CoV2 infection. The combination of air pollution and free heme toxicity, resulting from the interaction between an unstable hemoglobin variant and SARS-CoV2 infection, seems to be the best scheme to explain clinical and biological manifestations in severe COVID-19. The arguments to support this hypothesis are detailed. We also propose some strategies to verify the concordance of our hypothesis with the reality and the implications it could have, if verified, either for scientists and decision makers.

Autodialysis in Morocco: how much longer can we wait?

INTRODUCTION: Autodialysis is the dialysis performed by the patient himself at a local center instead of a hemodialysis center. In Morocco, the practice of hemodialysis dates back to 1970; however, an autodialysis center does not yet exist. The objective was to assess the potential medical fitness and adherence of the patients to an autodialysis program. METHODS: Descriptive and analytical multicenter study conducted in March 2015 involving patients from of eight hemodialysis centers in Casablanca (Morocco). The study was conducted in two steps: 1) a transversal assessment of the medical potential to achieve autodialysis that included 556 patients; 2) a survey of the autodialysis membership that included 383 out of 556 patients who were deemed eligible for autodialysis. RESULTS: The average age was 54.63 ± 15.16 years; the average of hemodialysis duration was 85.9 ± 78.1 months. Diabetic nephropathy (22.7%) was the predominant cause of kidney disease. The assessment of medical potential to achieve autodialysis highlighted that almost all of the patients were in good condition (93%), independent (81%), and those without major comorbidities were less than 76 years old. Regarding the potential patients' adherence to autodialysis, among the 383 patients previously deemed suited for autodialysis, 293 (76.5%) responded favorably to the proposal of self-dialysis. CONCLUSION: The practice of hemodialysis should be implemented in a short time in Morocco because our patients' profile is perfectly suitable to this therapeutic method especially when they are young, in good general condition, autonomous, without major comorbidities, and willing to learn.

Predictors of mortality in hemodialysis patients.

INTRODUCTION: Mortality in patients with chronic renal failure is high compared to the general population. The objective of our study is to evaluate the predictive factors related to mortality in hemodialysis. METHODS: This is a retrospective study involving 126 hemodialysis patients in the Nephrology Department of Ibn Rochd Hospital, Casablanca. Data were collected between January 2012 and January 2016. For each of our patients, we analyzed demographic, clinical, biological and anthropometric data. The Kaplan-Meier method and the log-rank test were used to evaluate and compare survival curves. To evaluate the effect of predictors of mortality, we used the proportional Cox hazard model. RESULTS: The analysis of the results showed that the surviving patients were younger than the deceased patients (43.07±13.52 years versus 53.09±13.56 years, p=0.001). Also, the latter has a significantly lower albumin and prealbumin levels (p=0.01 and p=0.04 respectively). Overall survival was 80.2%. Cox regression analysis at age (HR=1.26, p<0.0002), inflammation (HR=1.15, p<0.03), AIP> 0.24 (HR=2.1, p<0.002) and cardiovascular disease (RR=2.91, p<0.001) were associated with global and cardiovascular mortality. CONCLUSION: Our study showed that the mortality rate is high in our cohort. In addition, cardiovascular diseases, under nutrition and inflammation are predictive factors for mortality. Treatment and early management of these factors are essential for reducing morbidity and mortality.

Assessing the prevalence of protein-energy wasting in haemodialysis patients: A cross-sectional monocentric study.

INTRODUCTION: Protein-energy wasting (PEW) is a strong predictive factor for morbidity and mortality in haemodialysis (HD) patients. However, there is no consensus for its assessment. The present study aimed to assess the nutritional status of patients on chronic HD by use of different nutritional assessment parameters, and at verifying which can identify the greatest number of HD patients with PEW. Also, to investigate predictors of nutritional status in a haemodialysis center in Morocco. PATIENTS AND METHODS: This is a cross-sectional analysis performed on 126 patients aged 44.82±14.01 years, undergoing maintenance HD in the Department of nephrology of the university hospital centre of Casablanca, Morocco. Energy and nutrients intake assessment was obtained by a three-day period food recall. Biochemical parameters, bioelectric impedance analysis, and subjective global assessment (SGA), have been performed to assess nutritional status. RESULTS: According to SGA the prevalence of PEW was 74.62%. However, when using the ISRMN malnutrition criteria only 36.50% of the patients were diagnosed with PEW. Pearson correlation showed a negative association between the degree of malnutrition evaluated by SGA and serum prealbumin (r=-0.54; P=0.0001), serum albumin (r=-0.50; P=0.001), energy (r=-0.34; P=0.002), protein intake (r=-0.41; P=0.0001), and a significant positive correlation with CRP (r=0.65; P=0.0001) was determined, but not with anthropometric measurements nor lipids profile. The areas under the receiver operating characteristic curve were 0.841 (95% CI: 0.751-0.932) for serum prealbumin, and 0.737 (95% CI: 0.634-0.840) for serum albumin. CONCLUSION: Our results showed a high prevalence of PEW among Haemodialysis patients. Also, our findings suggest that SGA, serum albumin and prealbumin may be relative appropriate and practical markers for assessing nutritional status in HD patients.

[Valvular calcifications in a patient on hemodialysis in Morocco]. / Calcifications valvulaires chez l'hémodialysé au Maroc.

INTRODUCTION: Valvular calcifications are one of the major cardiovascular complications of hemodialysis because of its prevalence and its predictive indices of morbidity and mortality. There are many risk factors associated with these calcifications. Our study aims to evaluate both the prevalence of valvular calcifications in our patients on hemodialysis and their risk factors. METHODS: This was a single-center cross-sectional descriptive and analytical study of 111 adult patients who were on hemodialysis for more than 6 months at the hemodialysis center CHU Ibn Rushd, Casablanca and who underwent ETT during the year 2013. RESULTS: The average age of our patients was 44 ± 14 years. The average duration of hemodialysis was 146 ± 80 months. Average systolic blood pressure was 123 ± 23 mmHg and average diastolic blood pressure 72 ± 13 mmHg diastolic, average iPTH was 529 ± 460 pg/ml, mean serum calcium was 86 ± 10 mg/l and mean serum phosphate was 40 ± 15 mg/l. Mean CRP level was 11±19,8 mg/L. From the therapeutic point of view, 96% of patients were treated with calcium carbonate, 11% with 25 OH vitamin D, 55,5% with 1 hydroxy-vitamin D3. The prevalence of valvular calcification was 15% with aortic valve location in 41.2% and mitral valve location in 41.2%. In univariate analysis, only hemodialysis duration seems to be associated with the occurrence of calcifications and approaches marginal level of significance (p = 0.09). CONCLUSION: The prevalence of valvular calcification in our hemodialysis patients remains high even if it seems relatively low compared to the literature data. No known risk factor was significantly associated with these calcifications.

Chronic kidney disease, hypertension, diabetes, and obesity in the adult population of Morocco: how to avoid "over"- and "under"-diagnosis of CKD.

The prevalence of hypertension, diabetes, obesity, and chronic kidney disease (CKD) in an adult Arabic-Berber population was investigated according to 2012 KDIGO guidelines. A stratified, randomized, representative sample of 10,524 participants was obtained. Weight, height, blood pressure, proteinuria (dipstick), plasma creatinine, estimated glomerular filtration rate, and fasting glycemia were measured. Abnormal results were controlled within 2 weeks; eGFR was retested at 3, 6, and 12 months. The population adjusted prevalences were 16.7% hypertension, 23.2% obesity, 13.8% glycemia, 1.6% for eGFR under 60 ml/min/1.73 m(2) and confirmed proteinuria 1.9% and hematuria 3.4%. Adjusted prevalence of CKD was 5.1%; distribution over KDIGO stages: CKD1: 17.8%; CKD2: 17.2%; CKD3: 52.5% (3A: 40.2%; 3B: 12.3%); CKD4: 4.4%; CKD5: 7.2%. An eGFR distribution within the sex and age categories was constructed using the third percentile as threshold for decreased eGFR. A single threshold (under 60 ml/min/1.73 m(2)) eGFR classifying CKD3-5 leads to "overdiagnosis" of CKD3A in the elderly, overt "underdiagnosis" in younger individuals with eGFR over 60 ml/min/1.73 m(2), below the third percentile, and no proteinuria. By using the KDIGO guidelines in a correct way, "kidney damage" (confirmed proteinuria, hematuria) and the demonstration of chronicity of decreased eGFR <60 ml/min/1.73 m(2), combined with the third percentile as a cutoff for the normality of eGFR for age and sex, overcome false positives and negatives, substantially decrease CKD3A prevalence, and greatly increase the accuracy of identifying CKD.

Pulmonary hypertension: prevalence and risk factors.

INTRODUCTION: Pulmonary arterial hypertension (PAH), defined as a systolic pulmonary artery pressure above 35 mm Hg, is another vascular disease entity recently described in patients receiving hemodialysis. It is a major problem due to its high prevalence and morbidity and mortality. Its pathophysiological mechanism is just known and the strategies for its supported not yet defined. AIMS: To determine the prevalence of PAH in our hemodialysis patients and its risk factors. METHODOLOGY: Single center descriptive and analytical cross-sectional study, including 111 hemodialysis patients who had benefit from a trans-thoracic cardiac Doppler ultrasound during 2014. A value greater than or equal to 35 mm Hg is considered PAH and classified as follows: mild PAH (35 50 mm Hg), moderate PAH (50 70 mm Hg), and severe pulmonary hypertension (> 70 mm Hg). Patients with a high probability of secondary PAH, especially those with the following history: chronic obstructive pulmonary disease, pulmonary embolism, were not included. RESULTS: The mean age was 44.3 ± 14.2 years. Among the 111 patients, 18 had pulmonary arterial pressure above 35 mm Hg corresponding to 16.22% of PAH prevalence. The average pressure was 45 mm Hg. Of these 18 patients, 11.8% had mild PAH, 3.4% moderate PAH and 0.8% severe PAH. The average hemodialysis duration was significantly associated with PAH (p = 0.003); as well as valvular calcification (p = 0.000), mitral regurgitation (p = 0.001) and tricuspid regurgitation (p = 0.002). CONCLUSION: Primary pulmonary hypertension is a major problem among our hemodialysis because of its high prevalence and its risk factors.

[Falls among hemodialysis patients: Incidence and risk factors]. / Chutes chez l'hémodialysé : incidence et facteurs de risque.

Falls and mineral and bones disorders are both implicated in the occurrence of pathological fractures in patients undergoing chronic dialysis. However, data on falls among this population are rare. We carried out a prospective study during four weeks and included 70 patients on chronic hemodialysis with the main objectives being to evaluate the incidence of falls and factors related to it. At the end of the four weeks, 16 patients (22.86%) fell at least once, with a total of 17 falls during 4 weeks, giving an incidence of 3.2 falls per patient/year. The mean age was 40 ± 16 years. Five patients (31.2%) had a past history of pathological fractures. Ten patients (62.5%) presented intra- and post-dialysis hypotension, six (37.5%) was diagnosed of gait disorders and two (12.5%) had sensory deficit of the lower limbs. Six patients (37.5%) presented frailty. Hypotension (P=0.004), frailty (P=0.047) and sensory deficit (P=0.049) were significantly associated with the occurrence of falls. The incidence of falls is relatively high in our hemodialysis patients and real risk factors exist. Hence, it is important to implement programs for falls prevention to reduce their incidence and impact.

Outcome assessment of pregnancy-related acute kidney injury in Morocco: A national prospective study.

Acute kidney injury (AKI) is a rare but life-threatening complication of pregnancy. The aim of this paper is to study the characteristics of acute AKI in pregnancy and to emphasize on its management modalities in Moroccan hospitals. This is a national prospective study performed over six months from July 1 to December 31 2010 on AKI developing in pregnant patients, both preand post-partum period. Patients with pre-existing kidney disease were excluded from the study. Outcome was considered unfavorable when complete recovery of renal function was not achieved and/or maternal death occurred. Forty-four patients were included in this study. They were 29.6 ± 6 years old and mostly illiterate (70.6%). Most AKI occurred in the post-partum period, with 66% of the cases occurring in those who did not receive antenatal care. The main etiologies were pre-eclampsia (28 cases), hemorrhagic shock (six cases) and septic events (five cases). We noted three cases of acute fatty liver, one case of obstructive kidney injury and one case of lupus nephritis. Hemodialysis was necessary in 17 (38.6%) cases. The outcome was favorable in 29 patients. The maternal mortality rate was 11.4%. Two poor prognostic factors were identified: Age over 38 years and sepsis. AKI is a severe complication of pregnancy in developing countries. Its prevention necessitates the improvement of the sanitary infrastructure and the establishment of the obligatory antenatal care.

[Management of iodine-131 ablation therapy for thyroid carcinoma in a patient on chronic hemodialysis]. / Gestion d'un traitement ablatif par l'iode 131 d'un carcinome thyroïdien chez un patient hémodialysé chronique.

Iodine-131 ablation therapy for thyroid cancer in the patient on chronic hemodialysis represents a real problem since the main route of elimination of radioiodine is urinary. There is no recommendation on the management of this treatment in the patient on hemodialysis. We report our experience of management of this treatment in a patient aged 38 years, undergoing hemodialysis for chronic renal failure, and who have been indicated the treatment with iodine-131 for papillary thyroid carcinoma high risk. After multidisciplinary discussions (nephrologists and specialists in nuclear medicine and radiation safety), it has been decided to treat the patient with continuous ambulatory peritoneal dialysis therapy (CAPD). Because of the low but continuous elimination of iodine in the case of CAPD, the patient received a reduced ablative (131)I dose of 1850 MBq, which is 30% of the usual dose delivered in subjects with normal renal function. The patient was hospitalized for four days in nuclear medicine unit and the (131)I radioactivity emitted from him was 2.5 µSv/h at one meter at his hospital discharge. In conclusion, CAPD in relay of hemodialysis is a technique of renal replacement therapy that can be suggested to minimize exposure to radioactivity to the patient, his family and the medical staff.

[Estimate of the needs in renal transplantation in Morocco]. / Estimation des besoins en greffe rénale au Maroc.

Kidney transplantation is still underdeveloped in Morocco. In order to anticipate needs and discuss a possible reorganization of the provision of care, an estimate of the number of patients who would benefit from kidney transplant was conducted. This study was done in two steps. During the first step, based on the French renal replacement therapy registry (Rein), we develop a prediction score based on the likelihood of being treated by an autonomous dialysis (hemodialysis in self-care unit or peritoneal dialysis non-assisted by a nurse) and be registered on the national kidney transplant waiting list. During the second step, we apply this score to the data of the registry Magredial (Moroccan registry of renal replacement therapy, deployed in seven regions). Twelve parameters were related to autonomy and registration on the waiting list. Each of these parameters has been assigned a weight. Each patient was assigned a number of points, sum of different weights. By retaining a threshold of 21 points (80% specificity), 2260 subjects (57%) had a score less than or equal to this threshold in Magredial. With a number of patients on dialysis in Morocco estimated to 13,000 in late 2013, the estimated need for kidney transplant will be of 7410. This estimate should encourage professionals and health authorities of Morocco to engage more effort in the implementation of actions related to the transplant program.

Association of apolipoprotein E gene polymorphism with end-stage renal disease and hyperlipidemia in patients on long-term hemodialysis.

BACKGROUND: Cardiovascular diseases (CVDs) are the leading cause of death of patients with chronic renal failure. Apolipoprotein E (apoE) plays an important role in the homeostasis of cholesterol and triglycerides. OBJECTIVE: We aimed to investigate the possible link(s) between apoE gene polymorphism, inflammation and lipoproteins in hemodialysis patients. METHODS: We studied 109 end-stage renal disease (ESRD) patients and 97 controls. The serum lipids, apolipoproteins, lipoprotein particles, high-sensitivity C-reactive protein (hs-CRP) and total homocysteine (t-Hcy) levels and paraoxonase (PON) activity were determined in our patients. We also analyzed apoE gene polymorphism in the patients and controls. RESULTS: The analysis of the apoE gene demonstrated a predominance of the e3 allele in both the patients and controls, followed by the e4 and then the e2 alleles. The analysis of the apoE genotype and allele frequencies showed significantly higher e4 allele and E3E4 genotype frequencies and decreased e3 allele and E3E3 genotype frequencies in the patients compared with the controls. The e2, e4 and E3E4 carriers within the ESRD patient population presented an atherogenic lipid profile. However, there were no significant variations in the serum PON activity and the hs-CRP and t-Hcy levels between individuals with different apoE polymorphisms. CONCLUSIONS: Our findings suggest an association between the e4 allele, E3E4 genotype and ESRD. The apoE polymorphism affects the serum lipoprotein levels, and the ESRD patients who are e4 and e2 allele carriers are more likely to present an atherogenic lipoprotein profile that may be a major factor associated with increased risk of CVD.