Serum leptin level has a positive correlation with BMI and creatinine clearance in CAPD patients

Objective: In a cross sectional study, 75 patients (42 males and 33 females) on continuous ambulatory peritoneal dialysis (CAPD) were enrolled from October 2007 to February 2008. Serum levels of leptin, albumin, triglyceride, dialysis adequacy (total KTN), renal creatinine clearance (Cr Cl), mid arm circumference and demographic findings were measured in all patients. Results: The mean age of patients was 53+/-14.76. The history of hemodialysis was seen in 23 patients. Mean serum leptin level in women and men were 27+/-23 mu g/l and 16+/-13 mu g/l, respectively. A significant correlation of serum leptin level with body mass index (BMI) (p0.05). Conclusions: To our knowledge, this is probably the first study to report that serum leptin level has a direct positive correlation with renal Cr Cl in CAPD patients. This may explain the increase in mortality in patients with lower serum leptin levels (Tab. 2, Fig. 2, Ref. 25). Full Text in PDF www.elis.sk

The relationship of high-sensitivity C-reactive protein (Hs-CRP) serum level and peritonitis in patients on peritoneal dialysis

Background: C-reactive protein (CRP) is a predictor of cardiovascular diseases in both normal people and patients on hemodialysis. This study aimed to assess the relationship of high-sensitivity C-reactive protein (Hs-CRP) serum level and peritonitis in patients on peritoneal dialysis. Methods: 113 patients on peritoneal dialysis in Isfahan city, Iran, participated in our study in 2015. Serum albumin and Hs-CRP levels were measured in each patient at three times (baseline, and 6 and 12 month after that) and the patients were followed up for 1 year. All the patients were evaluated for peritonitis in every visit. At the end of the study, two groups of patients on peritoneal dialysis with and without peritonitis were compared. Findings: Among 113 patients, 24 were excluded from the study because of death or kidney transplantation and 89 patients were included in final analysis. The mean Hs-CRP levels in patients with peritonitis were 4.83, 5.79, and 7.42 mg/l at baseline, and 6 and 12 month after it, respectively; these levels were 4.47, 3.19, and 2.69 mg/l in patients without peritonitis, respectively. In addition, the mean albumin levels in patient with peritonitis were 3.38, 3.29 and 3.40 mg/l at baseline, and 6 and 12 month after it, respectively; these values were 3.56, 4.05, and 3.51 mg/l in patients without peritonitis, respectively. Conclusion: Results showed that with increase in Hs-CRP level, the risk of peritonitis increased. Besides, the albumin level decreased among patients with peritonitis in comparison with patients without peritonitis; there was no significant correlation between albumin level and peritonitis. © 2017, Isfahan University of Medical Sciences(IUMS). All rights reserved

Quality of Life of Patients on Peritoneal Dialysis and Contributing Factors: A Cross-Sectional Study

In recent years, interest in Health-Related Quality of Life (HRQoL) as a major indicator of clinical efficacy and treatment outcome in patients of End-Stage Renal Disease (ESRD) has grown significantly. This study aimed to determine the contributing factors affecting the quality of life (QoL) of ESRD patients undergoing peritoneal dialysis (PD). A cross-sectional study was conducted on PD patients presented at PD centres of Al-Zahra and Noor hospitals in Isfahan, Iran, from May to August 2019. A total of 173 patients having peritoneal dialysis for more than 3 months filled the validated 36-item short-form health survey questionnaire (SF-36). Baseline demographic details and dialysis-related factors were collected from patients’ medical records. The overall QoL score of patients was 50.28 ± 20.87. Male patients had a higher QoL score than female patients (58.18 in males, compared to 48.18 in females; P = 0.04). A significant association between frequency of dialysis and quality of life was observed, where three sessions of dialysis per day yielded the highest quality of life (QoL score = 59.62; P = 0.047). A significant positive correlation was discovered between QoL score and residual renal function (P = 0.013). In addition, a higher QoL score was observed in self-employed patients (60.95), compared to housewives (46.49) (P = 0.001). QoL assessment should be included as an integral part of patient follow-up to evaluate treatment outcomes and implement possible interventions to improve patient’s quality of life

Decoy Cell Viruria in Kidney Transplant Patients. Does it correlate with Renal Function?

Objective: BK virus (BKV) infection after kidney transplantation has been a topic of great interest in the recent decade. Prospective screening studies have revealed that BKVN is principally an early complication of renal transplantation occurring within the first post-transplant year in most cases. The aim of the present study was to observe the incidence of decoy cell viruria in renal transplant recipients. Furthermore, correlation of decoy cell viruria with graft function was assessed. Methods: This analytic cross-sectional study was conducted in the Transplant Center of Alzahra Hospital, Isfahan, Iran between Jun 2014 and June 2015. Clinical screening for polyomavirus infection was done by means of urine cytological evaluation for decoy cells. Urine samples were analyzed in three steps including 2-4 months after transplantation, three and six months later. Results: Thirty-three patients (22 male and 11 female) received kidney transplant from living donors. The average of patients' age was 41.9 +/- 12.83 (range: 20-63 years). Peritoneal and hemodialysis were used for 15.6% and 84.4% of recipients. The occurrence of decoy cell viruria at the time of enrollment, 3 and 6 months later was found in 18.2%, 10.7% and zero, respectively. Conclusion: As urine cytology is easy to perform and of low cost, it is a useful tool for the investigation of active polyoma virus infection. Moreover, the findings advocate that the presence of decoy cells along with high creatinine is a better indicator of the virus presence

Effects of Oral L-Carnitine Supplementation on Lipid Profile, Anemia, and Quality of Life in Chronic Renal Disease Patients under Hemodialysis: A Randomized, Double-Blinded, Placebo-Controlled Trial

In patients on maintenance hemodialysis several factors reduce the body stored carnitine which could lead to dyslipidemia, anemia, and general health in these patients. We evaluated the effect of oral L-carnitine supplementation on lipid profiles, anemia, and quality of life (QOL) in hemodialysis patients. In a randomized, double-blinded, placebo-controlled trial, end-stage renal disease (ESRD) patients on hemodialysis received either L-carnitine 1 g/d (n = 24) or placebo (27 patients) for 16 weeks. At the end of the study, there was a significant decrease in triglyceride (−31.1 ± 38.7 mg/dL, P = 0.001) and a significant increase in HDL (3.7 ± 2.8 mg/dL, P < 0.001) levels in the carnitine group. Decrease in total cholesterol (−6.6 ± 16.0 mg/dL, P = 0.075) and increase in hemoglobin (0.7 ± 1.7 g/dL, P = 0.081) concentrations in the carnitine group were not significant. There was no statistically significant changes in LDL in any group (P > 0.05). Erythropoietin dose was significantly decreased in both the carnitine (−4750 ± 5772 mg, P = 0.001) and the placebo group (−2000 ± 4296 mg, P < 0.05). No improvement was observed in QOL scores of two groups. In ESRD patients under maintenance hemodialysis, oral L-carnitine supplementation may reduce triglyceride and cholesterol and increase HDL and hemoglobin and subsequently reduce needed erythropoietin dose without effect on QOL

Limited knowledge of chronic kidney disease and its main risk factors among Iranian community: an appeal for promoting national public health education programs

Background: The aim of this survey was to explore the baseline knowledge of the Iranian community about Chronic Kidney Disease (CKD) definition and its two main risk factors, i.e. diabetes and hypertension. This study also introduced a model of public education program with the purpose of reducing the incidence of CKD in high-risk groups and thereby decreasing the economic burden of CKD in Iran. Methods: This cross-sectional study was conducted on world kidney day 2013 in Isfahan, Iran. Self-administered anonymous questionnaires evaluating the knowledge of CKD and its risk factors were distributed among subjects who participated in a kidney disease awareness campaign. Chi-square test and logistic regression analysis were used to examine the differences in the level of knowledge across different socio-demographic groups. Results: The questionnaires were completed by 748 respondents. The majority of these respondents believed that “pain in the flanks” and “difficulty in urination” was the early symptoms of CKD. Roughly, 10.4% knew that CKD could be asymptomatic in the initial stages. Only 12.7% knew diabetes and 14.4% knew hypertension was a CKD risk factor. The respondents who had a CKD risk factor (i.e. diabetes and/or hypertension) were significantly more likely than respondents without CKD risk factor to select “unmanaged diabetes” [Odds Ratio (OR)= 2.2, Confidence Interval (CI) ( 95%) : 1.4–3.6] and “unmanaged hypertension” [OR= 1.9, CI( 95%) : 1.2–3.0] as “very likely to result in CKD”. No more than 34.6% of all respondents with diabetes and/or hypertension reported that their physician has ever spoken with them about their increased risk for developing CKD. Conclusion: The knowledge of Iranian population about CKD and its risk factors is low. Future public health education programs should put efforts in educating Iranian community about the asymptomatic nature of CKD in its initial stages and highlighting the importance of regular renal care counseling. The high-risk individuals should receive tailored education and be encouraged to adopt lifestyle modifications to prevent or slow the progression of CK

Oxford-MEST classification in IgA nephropathy patients: A report from Iran.

BACKGROUND There is a limited knowledge about the morphological features of IgA nephropathy (IgAN)in the middle east region. OBJECTIVES The objective of this study was to evaluate the spectrum of histopathological findings in IgAN patients at our laboratory. PATIENTS AND METHODS At this work, an observational study reported which was conducted on IgAN patients using the Oxford-MEST classification system. RESULTS In this survey, of 102 patients 71.6 % were male. The mean age of the patients was 37.7 ± 13.6 years. Morphologic variables of MEST classification was as follows; M1: 90.2 %, E: 32 %, S: 67 % also,T in grads I and II were in 30% and 19% respectively, while 51% were in grade zero. A significant difference was observed in segmental glomerulosclerosis (P=0.003) and interstitial fibrosis/tubular atrophy frequency distribution (P= 0.045), between males and females . Furthermore, it was found that mesangial hypercellularity was more prevalent in yonger patients. Moreover, there was a significant correlation between serum creatinine and crescents (P<0.001). There was also significant correlation of serum creatinine with segmental glomerulosclerosis (P<0.001). CONCLUSIONS Higher prevalence of segmental glomerulosclerosis and interstitial fibrosis/ tubular atrophy, as the two of, four variables of Oxford-MEST classification of IgAN in male patients further attests that male gender is a risk factor in this disease.In this study the significant correlation between serum creatinine and crescent was in an agreement with previous studies and suggests for the probable accomodation of extracapillary proliferation as a new variable in MEST system

Granulomatosis with polyangiitis (Wegener’s) presenting as the right ventricular masses: A case report and review of the literature.

Background: Granulomatosis with polyangiitis (Wegener’s) is a systemic necrotizing vasculitis. Cardiac involvement in Wegener’s has rarely been reported. In this study the echocardiographic findings of granulomatosis with polyangiitis (GPA) in a patient is described. Case Presentation: The case was a 45 years old man admitted to the hospital with a 3 months history of persistent fever and sinusitis. Mild left and right ventricular enlargements as well as three small masses in the right ventricular cavity were identified in echocardiography. One mass was attached to the tricuspid valve and the other two masses were attached to the right septum. Pulmonary artery hypertension (45mmHg) was also reported. The masses responded dramatically to plasma exchanges in combination with steroid therapy, followed by oral cyclophosphamid and low-dose steroid therapy. In the kidney biopsy, 8 out of 11 golomeruli contained fibrous crescents along with sclerotic lesions. Spleen has 140 mm diameter with multiple echo-free lesions and coarse parenchyma in abdominal ultrasound. Serum C-ANCA=671, P-ANCA=1.7 (normal= up to 15U/mL). The diagnosis of granulomatosis with polyangiitis (Wegener’s) was established. Conclusions: Presence of three small masses in right ventricular cavity and pulmonary artery hypertension in association with the spleen lesions were an uncommon presentation of GPA. GPA should be considered in the differential diagnosis of any nonspecific illnesses with cardiac involvement

The efficacy of pharmaceutical combination of glucose, insulin, potassium, and magnesium along with thrombolytic therapy on the mortality of patients with acute myocardial infarction

BACKGROUND: Despite conventional treatment methods of acute myocardial infarction, its complications and mortality rates are still very high. Finding new cost-effective treatments like regulation of ischemic muscle metabolism at the time of thrombolytic therapy can meet this requirement to some extent. This study investigated the efficacy of the pharmaceutical combination of glucose, insulin, potassium (GIK) and magnesium along with thrombolytic therapy.METHODS: In a double-blind, controlled clinical trial, 200 patients with acute myocardial infarction who had the indication for thrombolytic treatment were selected and divided to 6 groups of almost 30 people. A specific treatment protocol was designed for each group. The patients in the first 5 groups were compared with the ones in the sixth group as the control group in terms of frequency of complications and in-hospital mortality and also mortality during 3 and 6 months after the treatment.RESULTS: Mean age of the patients was 58.77 &plusmn; 2.6 years. Males constituted 77% of the study population. Heart failure, in-hospital arrhythmia and ejection fraction (EF) at discharge showed favorable results in the five groups which received metabolic regulations as compared to the control group. In-hospital mortality of no groups was different from that of the control group (P &gt; 0.05). Three months after the treatment, mortality of the group that received GIK and magnesium was lower than that of the control group (P &lt; 0.05). After 6 months, none of the patients who received high-dose GIK and magnesium along with thrombolytic therapy died while the mortality rate of the control group was 44.4% (P &lt; 0.05).CONCLUSION: The infusion of GIK and magnesium solution along with thrombolytic therapy can lead to a decrease in the long-term mortality and complications in patients with acute myocardial infarction.Keywords: Acute Myocardial Infarction, Glucose, Insulin, Potassium, Magnesium, Thrombolytic Therapy, Cardiovascular Diseases, Clinical Tria

Comparison of the effect of co-trimoxazole and co-trimoxazole plus ciprofloxacin in urinary tract infection prophylaxis in kidney transplant patients

Background: Urinary tract infection (UTI) as an important infection in the setting of renal transplantation carries the high mortality and morbidity rate. Thus, the prevention of this infection should receive higher priority. However, bacterial resistance to antibiotics is on the rise, with limited data to guide prophylaxis. The purpose of this study was to compare the effect of sulfamethoxazole-trimethoprim (SMZ/TMP) and SMZ/TMP plus ciprofloxacin for prophylaxis of UTI in renal transplant recipients. Materials and Methods: In a clinical trial study, 50 patients were included and divided into two groups of 25 using block randomization. Patients in Group I received prophylactic SMZ/TMP and those in Group II received ciprofloxacin plus SMZ/TMP. The incidence of UTI in the two groups at 1, 3, and 6 months after transplantation was evaluated. This study was registered in Iranian Registry of Clinical Trial (IRCT number: IRCT 2015120823743N1). Results: Of the 61 patients older than 18 years at the time of transplantation, 50 were included. UTI was documented in 8 patients (32%) in Group I and 3 (12%) in Group II (P = 0.026). The average time for the development of the first case of infection was the same for both groups (P = 0.241), and it was at its maximum in the 1st month. Urinary infections caused by Escherichia coli, the dominant strain, were the same in both groups (P = 0.673). Conclusions: Our study shows that the addition of 1 month course of ciprofloxacin lowered the incidence of UTI. More studies are needed to confirm the efficacy of this approach