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Atherosclerotic changes in carotid arteries of hemodialysis (HD) patients reflect global atherosclerotic changes in vasculature. Carotid intima-media thickness (CIMT) can be used for atherosclerosis prediction and assessment of cardiovascular risks in HD patients, and thus screening high-risk patients. In this cross-sectional study, CIMT was measured using ultrasonography (B-mode with 5-10-MHz multifrequency linear probe) in HD patients in our hospitals. Additionally, we assessed the relationship between their CIMT and some cardiovascular risk factors. A total of 62 HD patients (64.5% male) were included. Age, body mass index, low-density lipoprotein, fasting blood sugar, history of diabetes mellitus and cardiovascular disease, serum albumin, and duration and adequacy of HD in study patients had significant association with their CIMT. There were no significant relationships between CIMT and patient′s gender, smoking, serum calcium, phosphate, calcium x phosphate product, hemoglobin, and uric acid level. More diagnostic modalities must be performed for detecting the impact of atherosclerosis on HD patients with high CIMT.

Background: Ischemic injury during organ transplantation increases the risk of acute and chronic rejections by promoting alloimmune responses. Measurement of neutrophil gelatinase-associated lipocalin (NGAL) immediately after kidney transplantation may be promising for early detection of ischemic injuries to allograft. Objective: This study assessed possible predictive values of plasma NGAL levels during first hours after kidney transplantation for graft loss within the first 3 months after transplantation. Methods: 45 kidney transplant recipients were classified into those without graft loss or with graft loss during 3 months after transplantation. Plasma NGAL levels were measured before and at 2, 6, 12, 24 and 96 hours after transplantation. Serum creatinine concentration was assessed daily during hospitalization and at 1, 2, and 3 months post-transplantation. Results: Serum creatinine and plasma NGAL levels were consistently higher in patients with graft loss compared with those without graft loss. At 2, 24, and 96 hours after transplantation, plasma NGAL concentration was significantly higher in patients who developed allograft loss within 3 months post-transplantation. The cutoff point of plasma NGAL at 2, 24, and 96 hours after transplantation for prediction of graft loss was 304.5 ng/mL (sensitivity of 71.4%, and specificity of 73.7%), 207.8 ng/mL(sensitivity of 85.7%, and specificity of 60.5%), and 184 ng/mL (sensitivity of 85.7%, and specificity of 71.1%), respectively. Conclusion: Plasma NGAL levels at 2, 24, and 96 hours after transplantation can predict 3-month graft loss with fair sensitivity and specificity.

Objectives To determine whether stone burden correlates with the degree of chronic kidney disease in kidney stone formers. Methods A total of 97 extracorporeal shockwave lithotripsy candidates aged 18 years and older were included. Size, number and location of the kidney stones, along with cumulative stone size, defined as the sum of diameters of all stones) were determined. Estimated glomerular filtration rate was determined using the Chronic Kidney Disease Epidemiology Collaboration cystatin C/creatinine equation, and chronic kidney disease was defined as estimated glomerular filtration rate

Introduction. Maintenance of kidney graft function is essential, averting infection and coinfection. Cytomegalovirus (CMV) and BK polyomavirus (BKV) coinfection have been reported. There are a few studies of CMV and BKV infection in kidney transplant recipients in Iran, but no studies of their coinfection. Objective. To assess the coexistence of CMV and BKV infection in renal transplant recipients. Patients and Methods. The presence of CMV and BKV was assessed using real-time polymerase chain reaction in a cross-sectional study in 91 renal transplant recipients at 1 month posttransplantation. Assessment of CMV was performed only in blood samples, whereas BKV was assessed in both serum and urine samples. Results. The 91 patients included 57 men (62.6%) and 34 women (37.4%), who ranged in age from 19 to 76 years. Simultaneous evaluation of CMV in plasma and BKV in urine demonstrated no significant association. Of 24 patients positive for BKV in urine, 8 (33.3%) were positive for CMV in plasma. Sixty-seven patients tested negative for BKV in urine, whereas 23 (34.4%) tested positive for CMV, which is unremarkable. Comparison of coinfection with plasma CMV and plasma BKV demonstrated no significant correlation. In 3 patients positive for BKV in plasma only, 1 (33.3%) was positive for CMV, whereas in 88 patients negative for BKV in plasma, 30 were positive for CMV. Conclusion. No significant association was observed between CMV and BKV infections in kidney transplant recipients.

Peritoneal dialysis is an established form of renal replacement therapy used in many patients with end-stage renal disease. The key to a successful chronic peritoneal dialysis is a permanent and safe access to the peritoneal cavity. This study was conducted in order to evaluate the catheter survival and its related factors in Imam Khomeini Hospital. A total of 80 catheters were inserted into 69 patients (52 men and 28 women) with end-stage chronic renal failure during a period of 84 months. Retrospectively the correlation between catheter survival (overall and event free) with demographic factors (sex and age), surgical factors (surgeons and surgical methods), nephrologic factors (the causes of peritoneal dialysis selection and the history of hemodialysis) and peritonitis factors (the history and number of peritonitis) has been evaluated. The mean age of the patients was 48.35 years (16 to 79 years). The overall survival of catheters or the probability of having a functioning catheter after one, two and three years was 53%, 41%, 22%, respectively. The event free survival of the catheter or the probability of having a functioning catheter without any problems after one year was 14%. It has been found out that among all factors in this study only history of hemodialysis had statistically significant effect on the overall survival of continuous ambulatory peritoneal dialysis catheter (P = 0.04). It seems that the overall survival of catheters is better when CAPD is started before any other attempts for hemodialysis.

Although protein-calorie malnutrition is common among the hemodialysis patients and is associated with increased rates of morbidity and mortality, assessment of nutritional status of these patients is frequently ignored in many dialysis centers. Malnutrition can be estimated using a semiquantitative scale, subjective global assessment (SGA) but subjective nature of this scale restricts its reliability. In this study, we evaluated the malnutrition status in 71 hemodialysis patients by a recently developed, fully quantitative scoring system, dialysis malnutrition score (DMS) instead of conventional SGA and compared the results with laboratory and anthropometric measurements of malnutrition. Consequently, this revealed that DMS significantly correlated with the anthropometric measurements and an important laboratory parameter, serum transferrin level. The conventional SGA had only significant correlation with anthropometric measurements. These results confirmed the role of SGA as a reliable method in assessment of malnutrition, but it must be performed by a physician or trained nurse and is time consuming. Regarding these limitations, we suggest DMS as an alternative method for SGA in assessment of nutritional status of hemodialysis patients.

Residual renal function (RRF) plays a key role in the follow-up of the patients undergoing chronic ambulatory peritoneal dialysis (CAPD). Available methods for measurement of RRF are cumbersome and rarely used, and alternatively, cystatin C-derived equations have been proposed.Seventy-six adult CAPD patients were recruited. RRF was measured using the 24-hour urea-creatinine clearance method. Serum concentrations of cystatin C were determined. Glomerular filtration rate (GFR) was estimated using the two published equations of Hoek and colleagues, and Yang and colleagues. GFR was also estimated from serum creatinine using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula.Patients (age range 18-86 years) were on CAPD for a median of 24 months. Average serum concentrations of cystatin C was 5 ± 1.2 mg/L. Average RRF was 0.7 ± 1.6 mL/min/1.73 m(2). All three methods significantly overestimated the measured RRF values (Hoek: 4 ± 1.4; Yang: 4.5 ± 1.5; 7.4 ± 4 mL/min/1.73 m(2)). Based on Bland-Altman plots, all three methods yielded poor agreement with RRF (p 0.001 for all tests), with Hoek's equation providing the narrowest limits of agreement [mean difference (limits of agreement): 3.4 (2.9-3.9)] and CKD-EPI the widest [6.7 (5.9-7.5)]. Although the Hoek's method outperformed CKD-EPI, the within 30 and 50% accuracy rates were unsatisfactory (10.5 and19.7 %, respectively).Cystatin C-derived equations outperform the CKD-EPI formula in approximating the RRF values. Yet, these methods still significantly overestimate the measured RRF and their routine application in clinical practice is not advised.

Background: With the success of kidney transplantation, liver disease has emerged as an important cause of morbidity and mortality in kidney recipients. Objective: To determine the impact of hepatitis B virus (HBV) infection on patients and graft survival in both short- and long-terms. Methods: 99 renal transplant patients infected with HBV on follow-up in two major transplant centers were included in a retrospective study. These patients were grafted between 1986 and 2005 and divided into two groups: (1) those only positive for hepatitis B surface antigen (HBsAg) and (2) those who were also positive for hepatitis C virus antibodies (HCV Ab). Results: There were 88 patients with HBsAg+ and 11 with both HBsAg+ and HCV Ab+. The mean±SD age of patients was 38.8±13.2 years, and the median follow-up after transplantation was 19 months. Although not significant, the allograft survival rate in the first group (HBV+) was better compared to that in the second group (HBV+ and HCV+); 1, 5 and 10 years graft survival rates were 91, 77 and 62 in the first group and 70, 56 and 28 in the second group, respectively (P=0.07). The overall mortality was 5% (4 of 88) in the first and 27% (3 of 11) in the second group (P=0.02). Conclusion: Renal allograft recipients with HBV and HCV infections has a poor survival rate compared to patients with only HBV infection. However, there is no significant difference in terms of renal graft survival between the two groups.

Background: With the success of kidney transplantation, liver disease has emerged as an important cause of morbidity and mortality in kidney recipients.Objective: To determine the impact of hepatitis B virus (HBV) infection on patients and graft survival in both short- and long-terms.Methods: 99 renal transplant patients infected with HBV on follow-up in two major transplant centers were included in a retrospective study. These patients were grafted between 1986 and 2005 and divided into two groups: (1) those only positive for hepatitis B surface antigen (HBsAg) and (2) those who were also positive for hepatitis C virus antibodies (HCV Ab).Results: There were 88 patients with HBsAg+ and 11 with both HBsAg+ and HCV Ab+. The mean±SD age of patients was 38.8±13.2 years, and the median follow-up after transplantation was 19 months. Although not significant, the allograft survival rate in the first group (HBV+) was better compared to that in the second group (HBV+ and HCV+); 1, 5 and 10 years graft survival rates were 91, 77 and 62 in the first group and 70, 56 and 28 in the second group, respectively (P=0.07). The overall mortality was 5% (4 of 88) in the first and 27% (3 of 11) in the second group (P=0.02).Conclusion: Renal allograft recipients with HBV and HCV infections has a poor survival rate compared to patientswith only HBV infection. However, there is no significant difference in terms of renal graft survival between the two groups.

Objective. Posttransplant diabetes mellitus (PTDM) is a common and serious complication of renal transplantation. Estimates of the incidence of PTDM after renal transplantation vary between 2% and 54%. The aim of the present study was to evaluate the incidence and risk factors for PTDM among our renal transplant patients. Patients and Methods. In this study we evaluated 121 nondiabetic patients with end-stage renal disease (ESRD) who underwent kidney transplantation for the first time at our centers since 2005. All patients received the same protocol of immunosuppressive therapy. PTDM was defined according to the clinical practice recommendations of the American Diabetes Association. Results. At 12 months following renal transplantation, 9.9% of patients developed PTDM. Patients with PTDM were significantly older (P .013) and had higher body mass index (P .001). There were significant differences (P .05) between PTDM and non-PTDM patients with respect to systolic blood pressure, serum triglycerides (TG), peritoneal dialysis as renal replacement therapy before transplantation, and duration of pretransplant dialysis therapy. Upon multivariate analysis, serum TG, systolic blood pressure, and body mass index were associated with PTDM (P .05). Conclusions. The incidence at 12 months of PTDM among our renal transplant recipients was 9.9%. The most important factors associated with PTDM were serum TG, systolic blood pressure, and body mass index.

Background. BK virus nephropathy (BKVN) is recognized as a cause of graft loss in renal transplant patients. The disorder may be related to the introduction of new, potent immunosuppressive regimens. We sought to assess the prevalence, outcome, and clinical characteristics of BKVN. Materials and Methods. We retrospectively analyzed 160 specimens from episode biopsies. BKVN was diagnosed by light microscopic examination and positive immunohistochemical staining. Results. Among 160 patients, 21 (13.1%) were diagnosed as BKVN. The mean interval between biopsy and transplantation was 13.6 ± 10.67 months. There were no significant differences between BKVN patients and non-BKVN patients with respect to age, sex, interval between diagnosis and transplantation, cyclosporine blood level, and azathioprine versus mycophenolate mofetil immunosuppression. Graft loss occurred in 57.1% of BKVN versus 12.2% of non-BKVN subjects (P = .005). There was a significant difference between antilymphocyte globulin (ALG)- and non-ALG-treated groups with respect to the incidence of BKVN (6.6% in non-ALG versus 19% in ALG groups; P

Hemodialysis (HD) patients have a high incidence of cardiovascular disease and increased premature mortality. N-3 polyunsaturated fatty acids (PUFAs) are known to decrease plasma triglyceride (TG) levels and have a cardio-protective effect in subjects with normal renal function. The aim of this study was to investigate the effect of Omega-3 on plasma lipid levels in patients on HD. We included 33 patients on HD with serum TG higher than 200 mg/dl and total cholesterol higher than 220 mg/dl, in the study and randomly assigned them to treatment with 2 gm pearls of Omega-3 per day, given in two equal doses or a control group who did not receive this drug. The study was conducted for a period of 12 weeks. Patients were evaluated by measurement of fasting plasma lipid levels before and after the use of Omega-3. There was a significant (28%) increase in high-density lipoprotein levels (P %) decrease in serum TG levels (P0.02) in the group that received Omega-3 supplement. There were no changes in total cholesterol or low-density lipoprotein levels in either group. Our study suggests that supplementation with low-dose Omega-3 has a favorable effect on plasma lipid levels in patients on HD.

Purpose This study was designed to compare the efficacy and safety of oral versus intravenous ganciclovir in high-risk kidney recipients. Methods Thirty-four, cytomegalovirus (CMV) seropositive recipients of kidneys from seropositive donors who had undergone antilymphocytic immunosuppressive therapy were assigned randomly to oral (1000 mg, three times a day, 12 weeks) versus intravenous (5 mg/kg, 2 weeks) ganciclovir prophylaxis. Follow-up was performed for 12 months. The patients were evaluated for clinical and laboratory outcomes regarding CMV serostatus, CMV disease, graft outcome, and ganciclovir side effects. Results Sixteen patients in the oral group and 14 in the intravenous group completed the study. CMV infection occurred in 6 (37.5%) and 5 (35.7%) cases in the oral and intravenous groups, respectively ( P = NS). The mean interval between prophylaxis initiation and the first positive CMV Ag result was 3 ± 2.19 months, with no significant difference between the two groups. Only two patients in the intravenous group experienced CMV diseases, which were not tissue-invasive. Acute rejection episodes were observed in nine out of 30 recipients, but it did not show any association with the prophylaxis regimen or CMV serostatus. The patients tolerated oral ganciclovir well; the compliance percent was 81.6%. No complication was reported. Conclusion Oral and intravenous ganciclovir showed no significant difference to reduce the rate of CMV infection among high-risk kidney recipients. Oral ganciclovir was also effective and safe for the prevention of CMV disease. Moreover, it seems that CMV infection was not associated with acute rejection episodes.

To investigate the incidence of unwanted pregnancy among kidney transplant recipients, we studied 86 pregnancies in 64 women with a transplanted kidney. Twenty-five pregnancies were unwanted (29.1%). Pregnancy was terminated by induced abortion in seven patients, and four pregnancies were lost due to spontaneous abortion with one intrauterine fetal death. Only 13 (52%) pregnancies resulted in a live birth. Most of the unwanted pregnancies occurred in women using coitus interruptus (92%) as the only method of contraception. It is concluded that because fertility greatly improves after kidney transplantation, it is necessary to have a family planning counseling session before surgery. If a patient is not interested in future pregnancy, an effective method of contraception should be offered. A woman who has decided against childbearing in the future may decide to have a tubal ligation at the time of transplantation surgery.

Little is known about relation of transplantation and bone. We conducted a study to find out the frequency and predictors of osteoporosis in kidney transplanted patients in Iran. DEXA (DPX-MD, GE, Lunar corporation, USA) used for BMD of 61 kidney transplanted patients. Calcium, phosphate, alkaline phosphatase, BUN, creatinine and PTH, were also measured. Fourty four percent of patients were men (27). Mean±SD of age of men and women was 44.3±10.44 and 40/7± 13.77, respectively. Mean±SD of transplant duration was 33.9± 33. 2 months Mean±SD of dialysis time was 12±14 months. 29.5% of patients had osteoporosis. Osteoporosis was significantly higher in subjects with BMI less than 19 kg/m2 (P= 0.007). Alkaline phosphatase had a negative relation with osteoporosis in neck (P= 0.001). Other parameters had no significant relationship with osteoporosis. High prevalence of osteoporosis found in Iranian kidney graft recipients. Screening and therapeutic intervention in these patients is urgently needed.