Correlation of quality of sleep or quality of life and some of blood factors in hemodialysis patients

چکیده: زمینه و هدف: علی رغم پیشرفت‌های زیادی که در درمان بیماری نارسایی مزمن کلیه صورت گرفته کیفیت زندگی به عنوان یک مشکل بزرگ در این گروه از بیماران به مخاطره افتاده است. با توجه به شیوع بالای اختلال خواب و مشکلات وابسته به آن در بیماران دیالیزی، این مطالعه با هدف بررسی ارتباط بین کیفیت خواب، کیفیت زندگی و بعضی فاکتورهای خونی در بیماران تحت درمان با همودیالیز نگهدارنده انجام شد. روش بررسی: این پژوهش یک مطالعه توصیفی- تحلیلی است که در 85 بیمار تحت درمان با همودیالیز نگه دارنده در سال 84- 83 انجام گرفته است. نمونه ها از بخش های همودیالیز سه بیمارستان آموزشی وابسته به دانشگاه علوم پزشکی تهران و ایران و براساس نمونه گیری مبتنی بر هدف انتخاب شدند. کیفیت خواب با استفاده از پرسشنامه کیفیت خواب پیتس برگ (PSQI) و کیفیت زندگی با استفاده از پرسشنامه کوتاه 36 سوالی (SF36) اندازه‌گیری شد. جهت تجزیه و تحلیل داده ها از آزمون های آماری t، من ویتنی، کای دو، تست دقیق فیشر و ضریب همبستگی اسپیرمن استفاده شد. یافته ها: 63 بیمار (71) کم می خوابیدند (نمره کل کیفیت خواب بیشتر از 5 بود). ابعاد روانی (MCS) و ابعاد فیزیکی (PCS)، ‌ارتباط معکوسی با نمره کل کیفیت خواب داشت (01/0

Diabetes: Changing the fate of diabetics in the dialysis unit

The prevalence of diabetes mellitus (DM) is very high worldwide. According to the World Health Organization in 2000 the worldwide prevalence of DM was 171,000,000. Diabetic nephropathy is a major vascular complication of DM. If DM is not treated early and adequately, many diabetic patients may reach end-stage renal disease (ESRD) secondary to advanced irreversible diabetic nephropathy. In many countries diabetic nephropathy has become the single most frequent cause of prevalent ESRD patients undergoing maintenance hemodialysis (MHD). In the early era of renal replacement therapy (RRT) by means of intermittent hemodialysis the prognosis of diabetic patients undergoing MHD was extremely poor and disappointing. While the prognosis of patients suffering from diabetic ESRD and maintained by chronic intermittent dialysis has greatly improved, the rehabilitation rate and survival of these patients continue to be worse than those of non-diabetic patients. A preexisting severely compromised cardiovascular condition, vascular access problems, diabetic foot disease, interdialytic weight gain, and intradialytic hypotension explain most of the less favorable outcome. Despite improved techniques and more aggressive medical therapy in recent years, a review of the fate of diabetics in dialysis units since 1972 reveals that these patients have had significant morbidity and mortality. We still have a long way to go in order to achieve more ideal outcomes for our patients. Most of the diabetic ESRD patients are still maintained by MHD, but they can choose other modalities of RRT such as chronic ambulatory peritoneal dialysis (CAPD), kidney and kidney plus pancreas transplantation. The results of different studies and national registries on the mortality and morbidity of ESRD patients being maintained on different modalities of dialysis are conflicting. It can be concluded that the two modalities of dialysis (CAPD and MHD) are almost comparable in terms of survival. The recent suggestions for nocturnal daily hemodialysis, short daily hemodialysis, and an integrative care approach for the management of diabetics with ESRD provides better promise for these patients. Copyright © 2007 S. Karger AG

Molecular study of PKD1 & PKD2 genes by linkage analysis and determining the genotype/phenotype correlations in several Iranian families with autosomal dominant polycystic kidney disease

Background: Autosomal dominant polycystic kidney disease (ADPKD) is an inherited disorder with genetic heterogeneity. Up to three loci are involved in this disease, PKD1 on chromosome 16p 13.3, PKD2 on 4q21, and a third locus of unknown location. Methods: Here we report the first molecular genetic study of ADPKD and the existence of locus heterogeneity for ADPKD in the Iranian population by performing linkage analysis on 15 affected families. Results: Eleven families showed linkage to PKD1 and two families showed linkage to PKD2. In two families, PKD1 markers are common in all affected members but PKD2 markers were not informative. Conclusion: The results of this study demonstrate significant locus heterogeneity in autosomal dominant PKD in Iran. Analysis of clinical data confirms a milder ADPKD phenotype for PKD2 families. Our results showed relatively high heterozygosity rates and PIC values for some markers, while the most informative markers were KG8 and 16AC2.5 for PKD1 gene and AFM224x6 for PKD2 gene

Association of elevated frequency of micronuclei in peripheral blood lymphocytes of type 2 diabetes patients with nephropathy complications

The increasing incidence of type 2 diabetes mellitus globally has increased the incidence of diabetes-associated complications such as nephropathy. DNA damage induced by oxidative stress might be one of the important mechanisms in the pathogenesis of diabetic complications. Two hundred Iranian individuals with the conditions of type 2 diabetes, diabetic nephropathy and nephropathy patients with no sign of diabetes and normal unaffected sex- and age-matched controls (50 in each group) were enrolled in the study. The background and the net levels of micronucleus (MN) formation as well as other cellular damages induced after in vitro treatment with 25 μg/ml of bleomycin (BLM) were evaluated using cytokinesis block MNs cytome assay (CBMN cyt) in peripheral blood lymphocytes. The background and net BLM-induced levels of MNs were significantly higher in all patient groups compared with the control (P < 0.01, P < 0.001, respectively). The frequency of MNs was significantly higher in those patients with prior incidence of nephropathy than those without. A positive association was observed between basal and net MN frequency among study groups and also between net genetic damages and serum creatinine value and duration of diabetes. The rate of basal and net apoptosis was significantly higher in patients with hyperglycemia. Our results indicate that increased genomic instability expressed as MNs is associated with nephropathy in all pathological stages. Therefore, implementation of MN assay in clinical level may potentially enhance the quality of management of patients with diabetes and its complications such as nephropathy. © 2016 The Author 2016. Published by Oxford University Press on behalf of the UK Environmental Mutagen Society. All rights reserved. For permissions, please e-mail: [email protected]

Recurrence of a neuroendocrine tumor of adrenal origin: a case report with more than a decade follow-up

Background: Neuroendocrine tumor (NET) with adrenocorticotropic hormone (ACTH) secretion are very rare. To our knowledge, no follow-up study is published for ACTH-secreting NET, regardless of the primary site, to show second occurrence of tumor after a long follow-up, following resection of primary tumor. Case presentation: Here, we describe a 49-year-old-man with cushingoid feature, drowsiness and quadriparesis came to emergency department at December 2005. Laboratory tests revealed hyperglycemia, metabolic alkalosis, severe hypokalemia, and chemical evidence of an ACTH-dependent hypercortisolism as morning serum cortisol of 57 μg /dL without suppression after 8 mg dexamethasone suppression test, serum ACTH level of 256 pg/mL, and urine free cortisol of > 1000 μg /24 h. Imaging showed only bilateral adrenal hyperplasia, without evidence of pituitary adenoma or ectopic ACTH producing tumors. Importantly, other diagnostic tests for differentiating Cushing disease (CD) from ectopic ACTH producing tumor, such as inferior petrosal sinus sampling (IPSS), corticotropin releasing hormone (CRH) stimulation test, octreotide scan or fluorodeoxyglucose (FDG)-positron emission tomography (PET) scan were not available in our country at that time. Therefore, bilateral adrenalectomy was performed that led to clinical and biochemical remission of hypercortisolism and decreased ACTH level to < 50 pg/mL, findings suggestive of a primary focus of NET in adrenal glands. After 11 years uncomplicated follow up, the ACTH level elevated up to 341 pg/mL and re-evaluation showed a 2 cm nodule in the middle lobe of the right lung. Surgical excision of the pulmonary nodule yielded a carcinoid tumor with positive immunostaining for ACTH; leading to decrease in serum ACTH level to 98 pg/mL. Subsequently after 7 months, serum ACHT levels rose again. More investigation showed multiple lung nodules with metastatic bone lesions accompanied by high serum chromogranin level (2062 ng/mL), and the patient managed as a metastatic NET, with bisphosphonate and somatostatin receptor analogues. Conclusion: This case of surgically-treated NET showing a secondary focus of carcinoid tumor after one decade of disease-free follow-up emphasizes on the importance of long-term follow-up of ACTH-secreting adrenal NET. © 2021, The Author(s)

Metabolic risk factors and risk of Covid-19: A systematic review and meta-analysis

Objective Based on the epidemiologic findings of Covid-19 incidence; illness and mortality seem to be associated with metabolic risk factors. This systematic review and meta-analysis aimed to assess the association of metabolic risk factors and risk of Covid-19. Methods This study was designed according to PRISMA guidelines. Two independent researchers searched for the relevant studies using PubMed, Web of Science, Cochrane Library, and Scopus. The search terms developed focusing on two main roots of "Covid-19"and "metabolic risk factors". All relevant observational, analytical studies, review articles, and a meta-analysis on the adult population were included in this meta-analysis. Meta-analysis was performed using the random effect model for pooling proportions to address heterogeneity among studies. Data were analyzed using STATA package version 11.2, (Stata- Corp, USA). Results Through a comprehensive systematic search in the targeted databases we found 1124 papers, after running the proses of refining, 13 studies were included in the present meta-analysis. The pooled prevalence of obesity in Covid-19 patients was 29 (95 CI: 14-47). For Diabetes and Hypertension, these were 22 (95 CI: 12 33) and 32 (95 CI: 12 56), respectively. There was significant heterogeneity in the estimates of the three pooled prevalence without any significant small-study effects. Such warning points, to some extent, guide physicians and clinicians to better understand the importance of controlling co-morbid risk factors in prioritizing resource allocation and interventions. Conclusion The meta-analysis showed that hypertension is more prevalent than obesity and diabetes in patients with Covid-19 disease. The prevalence of co-morbid metabolic risk factors must be adopted for better management and priority settings of public health vaccination and other required interventions. The results may help to improve services delivery in COVID-19 patients, while helping to develop better policies for prevention and response to COVID-19 and its critical outcomes. © 2020 Moazzami et al

The role of hemodialysis machines dedication in reducing Hepatitis C transmission in the dialysis setting in Iran: A multicenter prospective interventional study

BACKGROUND: Hepatitis C virus (HCV) infection is a significant problem among patients undergoing maintenance hemodialysis (HD). We conducted a prospective multi-center study to evaluate the effect of dialysis machine separation on the spread of HCV infection. METHODS: Twelve randomly selected dialysis centers in Tehran, Iran were randomly divided into two groups; those using dedicated machines (D) for HCV infected individuals and those using non-dedicated HD machines (ND). 593 HD cases including 51 HCV positive (RT-PCR) cases and 542 HCV negative patients were enrolled in this study. The prevalence of HCV infection in the D group was 10.1% (range: 4.6%– 13.2%) and it was 7.1% (range: 4.2%–16.8%) in the ND group. During the study conduction 5 new HCV positive cases and 169 new HCV negative cases were added. In the D group, PCR positive patients were dialyzed on dedicated machines. In the ND group all patients shared the same machines. RESULTS: In the first follow-up period, the incidence of HCV infection was 1.6% and 4.7% in the D and ND group respectively (p = 0.05). In the second follow-up period, the incidence of HCV infection was 1.3% in the D group and 5.7% in the ND group (p < 0.05). CONCLUSIONS: In this study the incidence of HCV in HD patients decreased by the use of dedicated HD machines for HCV infected patients. Additional studies may help to clarify the role of machine dedication in conjunction with application of universal precautions in reducing HCV transmission

New Options for Iron Supplementation in Maintenance Hemodialysis Patients

End-stage renal disease results in anemia caused by shortened erythrocyte survival, erythropoietin deficiency, hepcidin-mediated impairment of intestinal absorption and iron release, recurrent blood loss, and impaired responsiveness to erythropoiesis-stimulating agents (ESAs). Iron malabsorption renders oral iron products generally ineffective, and intravenous (IV) iron supplementation is required in most patients receiving maintenance hemodialysis (HD). IV iron is administered at doses far exceeding normal intestinal iron absorption. Moreover, by bypassing physiologic safeguards, indiscriminate use of IV iron overwhelms transferrin, imposing stress on the reticuloendothelial system that can have long-term adverse consequences. Unlike conventional oral iron preparations, ferric citrate has recently been shown to be effective in increasing serum ferritin, hemoglobin, and transferrin saturation values while significantly reducing IV iron and ESA requirements in patients treated with HD. Ferric pyrophosphate citrate is a novel iron salt delivered by dialysate; by directly reaching transferrin, its obviates the need for storing administered iron and increases transferrin saturation without increasing serum ferritin levels. Ferric pyrophosphate citrate trials have demonstrated effective iron delivery and stable hemoglobin levels with significant reductions in ESA and IV iron requirements. To date, the long-term safety of using these routes of iron administration in patients receiving HD has not been compared to IV iron and therefore awaits future investigations