Serum cystatin C: A surrogate marker for the characteristics of peritoneal membrane in dialysis patients

To evaluate whether cystatin C levels can be a surrogate marker of creatinine clearance and reflect the characteristics of peritoneal membrane in dialysis patients, we performed peritoneal equilibration tests (PET) in 18 anuric adult chronic peritoneal dialysis (PD) patients with a mean age of 39.7 ± 20 years. All the samples were analyzed for urea, creatinine, and cystatin C. Peritoneal transport, mass transfer, and peritoneal clearance of cystatin C were calculated. Correlation and regression analysis was done using cystatin C as a dependent variable and age, sex, height, weight, body surface area, and creatinine as independent variables. Cystatin C demonstrated a significant time dependent increase of dialysate concentration and decline in the serum concentrations during PET, and a strong correlation between serum creatinine and serum cystatin C concentrations(r: 0.62, p= 0.008). The trans-peritoneal clearance (mL/min/1.73 m 2 ) of cystatin C was related to its serum concentration and was similar to creatinine in its pattern but of smaller magnitude. Peritoneal mass transfer (mg/4 hr per 1.73 m 2 ) for cystatin C serum creatinine was 1.68 ± 0.67 and 73.3 ± 29.8, respectively. The dialysis/plasma D/P cystatin C concentration was > 0.1 at 4 hrs of PET denoted high peritoneal transport, while the values of < 0.1 denoted low transport type. We conclude that cystatin C follows the same pattern of peritoneal exchange as creatinine but the magnitude of transfer is many folds lower than creatinine. At present clinical utility of cystatin C in the evaluation of solute clearance is probably limited due to the minute amounts transferred across the membrane and the high renal clearance in the presence of residual renal function

Microvascular and macrovascular complications in diabetic nephropathy patients referred to nephrology clinic

To evaluate the diabetic complications and fate of diabetic nephropathy in Saudi population, we studied 184 diabetic nephropathy (DN) patients who were referred to nephrology clinic of King Khalid University Hospital, Riyadh, Saudi Arabia from January 2003-June 2006. The patients had mean age of 61.9 ± 13.1 years, included 128 (69.6%) males, and were followed up for a mean period of 10.2 ± 1.5 years. The mean duration of diabetes mellitus (DM) was 19.5 ± 5.8 years, and duration of nephropathy was 7.7 ± 3.3 years. Family history of DN was documented in 52 (28.2%) patients. At initial visit, the mean systolic blood pressure was 164 ± 14.5 mmHg, the mean diastolic blood pressure was 97.9 ± 10.4 mmHg. Thirty-seven (20%) patients had normal BMI, 88 (48%) were overweight, while 55 (30%) were obese. Mean creatinine clearance was 51.7 ± 26.3 mL/min, 24 hrs urinary proteins 1.99 ± 2.48 gm/day, HbA1C 9.2 ± 1.8 %, triglyceride 2.1 ± 1.3 mmol/L, and cholesterol 5.17 ± 1.54 mmol/L. Diabetic complications included angiography proven coronary artery disease in 106 (57.6 %) patients, stroke in 21 (11.4%), myocardial infarction (MI) in 27(14.6%), angina in 87 (47.2 %), retinopathy in 82 (44.5%), Blindness in 3 (1.6%), peripheral vascular disease in 121 (65.7%), Neuropathy in 123 (66.8%), hypertension in178 (96.7%), diabetic foot in 25 (13.5%), Amputation in 10 (5.4%), and end-stage renal disease in 70 (38%). Total of 13 (7.05%) patients died in the hospital. Thirty-seven percent of patients developed > 6 concomitant complications. 28% developed 5, 17% developed 4, and the rest developed < 3. DN was relatively refractory to therapy and progressive; 123 (66.8%) patients doubled their serum creatinine in 3.59 ± 2.88 years, 32 (17.3%) maintained stable renal function, 136 (73.6 %) deteriorated, and 12 (6.52%) improved. we conclude that the prevalence of diabetic complications is high among Saudi patients, and many had multiple complications. Baseline creatinine clearance and proteinuria, high systolic blood pressure, advanced age, and longer duration of diabetes were the most significant risk factors for developing complications

Normal Reference Levels of Serum Cystatin C in Saudi Adults

This is the first report from Saudi Arabia studying the normal reference intervals in adult Saudi subjects and evaluating serum cystatin C as a prospective marker for the assessment of the glomerular filtration rate (GFR). Three hundred healthy adult Saudi subjects including 156 males (52%) and 144 females (48%), with a mean age of 31.21 ± 9.82 years were prospectively studied to establish normal reference ranges for cystatin C. A total of 68.34% of the study patients were in the age-group of 21-40 years. The mean serum cystatin C in the 300 healthy subjects was 0.751 ± 0.11 mg/L (0.50 - 1.09), increasing gradually with age: it was 0.738 ± 0.11 mg/L (0.51 - 1.09) in the age-group 21 - 30 years and 0.807 ± 0.12 (0.51 - 1.09) among subjects who were > 50 years of age. The mean serum cystatin C in females (0.778 ± 0.118 mg/L) was significantly hig-her than in males (0.726 ± 0.095 mg/L) (p < 0.0001). The serum cystatin C level was within the defined reference range of 0.53 - 0.95 mg/L in 95% of the subjects with a mean value of 0.74 ± 0.097 mg/L, and was falling within the 95% confidence interval of 0.73865 - 0.7637 mg/L, and with 98.84% area under the curve (AUC). All the other renal function markers (urea, serum crea-tinine, calculated GFR, BMI) among the studied subjects were within the normal reference ranges for adult Saudi population. The serum cystatin C level had a significant correlation with the body mass index (BMI) (r = 0.155; p = 0.007) and a correlation with serum creatinine as well (r = 0.009; p = 0.873). It showed a negative correlation with calculated GFR as per Cockroft-Gault equation (r = - 0.101; p = 0.083)

Analysis of causes of mortality in patients with autosomal dominant polycystic kidney disease: A single center study

This study was aimed at determining the median survival and most frequent causes of death in patients with the Autosomal Dominant Polycystic Kidney Disease (ADPKD). A retrospective, observational analysis was made on patients registered with a diagnosis of ADPKD, in the computer records of the Sheffield Kidney Institute (SKI), United Kingdom, during the years 1981 to 1999. Data on 363 patients were analyzed from these computer records and further infor-mation, if any, was obtained from the patients′ clinical notes. During this period, 88 patients died. The median age of the patients who died was 60.5 years, with the youngest being 37 years old and the oldest being 82 years. The major causes of death in this study group were cardiovascular (46.6%), infection (15.9%), central nervous system (CNS) disorders (11.36%), and miscellaneous causes (11.36%). Our study suggests that the major cause of death in patients with ADPKD was cardiovascular followed by infection, of which 42% of the deaths were due to septicemia. CNS causes of death comprised 11.36% of whom 60% had cerebrovascular events including sub-arachnoid hemorrhage in 20% of the patients. Uremia was the cause of death in only 2.2% of the patients in this series

Validation of predictive equations for glomerular filtration rate in the Saudi population

Predictive equations provide a rapid method of assessing glomerular filtration rate (GFR). To compare the various predictive equations for the measurement of this parameter in the Saudi population, we measured GFR by the Modification of Diet in Renal Disease (MDRD) and Cockcroft-Gault formulas, cystatin C, reciprocal of cystatin C, creatinine clearance, reciprocal of creatinine, and inulin clearance in 32 Saudi subjects with different stages of renal disease. We com-pared GFR measured by inulin clearance and the estimated GFR by the equations. The study included 19 males (59.4%) and 13 (40.6%) females with a mean age of 42.3 ± 15.2 years and weight of 68.6 ± 17.7 kg. The mean serum creatinine was 199 ± 161 μmol/L. The GFR measured by inulin clearance was 50.9 ± 33.5 mL/min, and the estimated by Cockcroft-Gault and by MDRD equations was 56.3 ± 33.3 and 52.8 ± 32.0 mL/min, respectively. The GFR estimated by MDRD revealed the strongest correlation with the measured inulin clearance (r= 0.976, P= 0.0000) followed by the GFR estimated by Cockcroft-Gault, serum cystatin C, and serum creatinine (r= 0.953, P= 0.0000) (r= 0.787, P= 0.0001) (r= -0.678, P= 0.001), respectively. The reciprocal of cystatin C and serum creatinine revealed a correlation coefficient of 0.826 and 0.93, respectively. Cockroft-Gault for-mula overestimated the GFR by 5.40 ± 10.3 mL/min in comparison to the MDRD formula, which exhibited the best correlation with inulin clearance in different genders, age groups, body mass index, renal transplant recipients, chronic kidney disease stages when compared to other GFR predictive equations

Prevalence of Anemia and Associated Factors in Child Bearing Age Women in Riyadh, Saudi Arabia

Objective. To determine the prevalence and risk factors for anemia in child bearing age women in Riyadh, Saudi Arabia. Design. Cross-sectional survey was conducted using two-stage cluster sampling. 25 clusters (primary health care centers (PHCC)) were identified from all over Riyadh, and 45–50 households were randomly selected from each cluster. Eligible women were invited to PHCC for questionnaire filling, anthropometric measurements, and complete blood count. Blood hemoglobin was measured with Coulter Cellular Analysis System using light scatter method. Setting. PHCC. Subjects. 969 (68%) women out of 1429 women were included in the analysis. Results. Mean hemoglobin was 12.35 (±1.80) g/dL, 95% CI 12.24–12.46 with interquartile range of 1.9. Anemia (Hb <12 g/dL) was present in 40% (390) women. Mean (±SD) for MCH, MCV, MCHC, and RDW was 79.21 (±12.17) fL, 26.37 (±6.21) pg, 32.36 (±4.91) g/dL, and 14.84 (±4.65)%, respectively. Multivariate logistic regression revealed that having family history of iron deficiency anemia (OR 2.91, 95% CI 1.78–4.76) and infrequent intake of meat (OR 1.54, 95%CI 1.15–2.05) were associated with increased risk of anemia, whereas increasing body mass index (OR 0.95, 95% CI 0.92–0.97) was associated with reduced risk of anemia. Conclusion. Women should be educated about proper diet and reproductive issues in order to reduce the prevalence of anemia in Saudi Arabia

Diabetes complications in 1952 type 2 diabetes mellitus patients managed in a single institution

Background and Objectives: Because there is no recent update on the state of diabetes and its concomi--tant complications in Saudi Arabia , we undertook a study of the prevalence of health complications in patients with type 2 diabetes mellitus admitted to our institution. Methods: We conducted a retrospective review of medical records of adult Saudi patients with type 2 diabetes who were seen in clinics or admitted to the Security Forces Hospital , Riyadh , Saudi Arabia , between January 1989 and January 2004. Results: Of 1952 patients , 943 (48.3&#x0025;) were males. For the whole study population the mean age at enrollment was 58.4&#x00B1;14.2 years , the mean age at onset of diabetes was 48.1&#x00B1;12.8 years , the mean duration of diabetes was 10.4&#x00B1;7.5 years , and the mean duration of follow-up was 7.9&#x00B1;4.6 years. Nephropathy was the most prevalent complication , occurring in 626 patients (32.1&#x0025;). Acute coronary syndrome occurred in 451 (23 .1 &#x0025;), cataracts in 447 (22.9&#x0025;) , retinopathy in 326 (16.7&#x0025;) , and myocardial infarction in 279 (14.3&#x0025;) , Doubling of serum creatinine was seen in 250 (12.8&#x0025;) and 79 (4.0&#x0025;) went into dialysis. Hypertension was present in 1524 (78.1&#x0025;) and dyslipidemia in 764 (39.1&#x0025;). Overall mortality was 8.2&#x0025;. Multiple complications were frequent. Males had higher prevalence of complications than females (P&#60; .05). Mortality was significantly higher in males 92 (9.8&#x0025;) than females 69 (6.8&#x0025;) (P=.024). The prevalence of complications significantly increased with dura--tion of diabetes and age (P&#60; .05). Conclusion: Among Saudis, the prevalence of concomitant diabetic complications is high, with cardiovas--cular and renal complications the most frequent. Many patients had multiple complications. Early and frequent screenings in the patients with type 2 diabetes are desirable to identify patients at high risk for concomitant complications and to prevent disabilities

Comparison of high and low dose of cyclophosphamide in lupus nephritis patients: A long-term randomized controlled trial

To evaluate the outcome of low doses of cyclophosphamide (Cyclo) therapy in lupus nephritis (LN) patients, we studied 117 biopsy-proven, de novo LN WHO class IV patients double-blinded and randomized in December 1997 to receive Cyclo in different doses; Group I (n=73) received Cyclo 10 mg/kg monthly for six months then every two months for 12 months. Group II (n=44) received Cyclo 5 mg/kg monthly for six months then every two months for 36 months. The patients were followed-up till January 2007. Six months post-induction values for creatinine clearance were significantly higher in Group I (67.7 ± 28.6 mL/min) compared with Group II (55.1 ± 30.1 mL/min), P = 0.026. Serum C4 and ANA were not significantly different between the groups (P > 0.05). At the mean follow-up of 6.77 ± 3.3 years, the mean creatinine clearance was 44.74 ± 31.7 mL/min in Group I vs. 49.3 ± 38.8 in Group II. Urinary protein was 1.65 ± 1.8 g/dL in Group I vs. 1.02 ± 1.01 in Group II (P = 0.03). The survival curve showed that kidney survival overtime was comparable in both groups (P = 0.2). Complete remission was observed in 25 (34.2%) patients in Group I vs. 11 (25%) in Group II (P = 0.288), while partial remission was similar in both groups; 43 (58.9%) patients in Group I vs. 26 (59%) patients in Group II. End-stage renal disease was observed in 10 (13.7%) patients in Group I vs. 9 (20.4%) patients in Group II (P = 0.359). Side-effects were more frequent in Group I patients than in Group II patients; gonadal toxicity and malignancy were lower in Group II patients (P = 0.0000). Moreover, different infections occurred in 23 (31.3%) patients vs. six (13.6%), digital infarcts occurred in 1.35% vs. 0%, diabetes in 4.1% vs. 2.27%, and vasculitis in 4.1% vs. 2.27% in Group I vs. Group II, respectively. Sustained amenorrhea without pregnancy was observed in both groups; however, significantly more in Group I patients, P ≤ 0.05. We conclude that low-dose Cyclo therapy is sufficiently effective for WHO class IV LN patients with lower side-effects compared with standard dose