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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.

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.

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.

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.

Background: The prognosis of chronic dialysis patients is poor, in part due to the high incidence of cardiovascular disease and malnutrition. It has been recognized that 30-50% of hemodialysis patients have serological evidence of an activated inflammatory response. Chronic inflammation may cause malnutrition and progressive atherosclerotic cardiovascular disease. It would be obvious interest to study prevalence of inflammatory factors particularly CRP as prominent components of inflammatory syndrome in dialysis patients. The objective of this study was to study prevalence of inflammatory factors particularly C-reactive protein (CRP) in hemodialysis patients. Methods: We studied 125 dialysis patients in a cross sectional study during summer of 2001 in two university hospitals. Serum CRP (agglutination method), albumin (bromocresol green method) and ferritin (ELISA) were measured in all patients. Results: One hundred and twenty five patients including 53 (44.1%) men and 72 (55.9%) women were enrolled in this study. Fourteen patients (11.2%) had hypoalbuminemia, 81 (64.8%) had high serum ferritin, and 57 subjects (45.6%) were CRP positive. Conclusion: According to high prevalence of inflammatory factors especially C-reactive protein in dialysis patients, CRP and other inflammatory factors should be screened in this group of patients routinely because of their prognostic importance.

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.

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.