Search

Introduction: Over a period of time, kidney blood vessels will be damaged in those patients suffering from hypertension. Objectives: This study aimed to investigate the effect of mean arterial pressure during cardiopulmonary bypass (CBP). Patients and Methods: The present observational prospective study was conducted on 90 high risk patients, having records of hypertension and being candidates for open heart surgery. Patients divided into three groups based on their mean arterial pressure (MAP), lower than 60 mmHg (first group), between 60 to 70 mm Hg (second group) and higher than 70 mm Hg (third group) respectively during cardiopulmonary bypass. Clinical outcomes being studied included cardiac surgery-associated acute kidney injury (CSA-AKI) (RIFLE class), serum creatinine levels, glomerular filtration rate (GFR) and urinary output up to 24 hours after the surgery. Results: Data related to 90 case-patients have been analyzed. There was no difference between the groups in terms of demographic information. Prevalence of AKI in preliminary course after cardiac surgery was different among the groups. AKI occurred in six patients (15%) of the first group, five patients (12.5%) of the second group and two patients (5%) of the third group (P = 0.03). There have been no differences in terms of serum creatinine levels, GFR and urinary output during 24 hours after cardiac surgery, among the groups. However, delta creatinine level and delta GFR were significant in those groups with MAP of lower than 60 mm Hg and also between 60-70 mm Hg. Conclusion: This study showed that MAP level during CBP directly affects occurrence of AKI in patients after open heart surgery. High risk patients such as those suffering from hypertension have to be constantly monitored during CBP regarding their MAP. We concluded that MAP drops to lower than 70 mm Hg has to be prevented in hypertensive patients.

Background Outbreaks of sterile or chemical peritonitis are uncommon and often not well documented. It is therefore important to describe the characteristics of sterile peritonitis in continuous peritoneal dialysis (PD) patients. Methods Characteristics of acute chemical peritonitis (ACP) are described in 20 patients (5 males, 15 females; mean age 50 ± 15 years; range 29 – 72 years). Cultures and Gram stains were negative for micro-organisms. All patients with symptoms of peritonitis were using glucose bags with the same lot number and resolution of peritonitis occurred only after changing the suspicious bags. The first measurements of dialysate-to-plasma creatinine (D/P creat) and glomerular filtration rate (GFR) before and after ACP were compared in 14 patients with no separate episode of bacterial peritonitis during that time. Results Cloudy dialysate was observed in 19 patients and 13 experienced abdominal pain. Mean dialysate white blood cell count and percentage neutrophils were 520/mm3 (range 100 – 1600/mm3) and 65% (range 14% – 98%) respectively. Analysis of the unused PD solution showed that endotoxin (0.06 endotoxin unit/mL), 5-hydroxymethyl furaldehyde (8 μg/mL), and acetaldehyde (0.4 μg/mL) concentrations were within acceptable ranges. In 14 patients without episodes of bacterial peritonitis, D/P creat was significantly higher after than before ACP (0.77 ± 0.07 vs 0.55 ± 0.1, p = 0.036), whereas GFR was not (4.5 ± 2.9 vs 4.9 ± 2.53 mL/minute, p = 0.62). Conclusion Although chemical peritonitis in glucose-based PD solution is uncommon, it should be distinguished from bacterial peritonitis in outbreaks of peritonitis. Facilities to measure glucose degradation products are required, especially in developing countries. Acute chemical peritonitis increases small-molecule transport in the short term.

Background: Obesity is a risk factor that has been associated scientifically with hypertension, diabetes, hyperlipidemia, cancer and other life threatening diseases. The results of some studies have also shown that obesity is an independent risk factor for the development and progression of renal damage. Objectives: The aim of the current study is to define which general and central obesity anthropometric indices are better predictors for ceratinine clearance (CC) in healthy, normal and obese Iranian women. Patients and Methods: In this case-controlled study, a total of 62 healthy, normal and obese women from 18 to 30 years of age in Zahedan City, the Islamic Republic of Iran, were studied. The subjects were classified into two groups; case group (31 subjects) of healthy obese women (30 ≤ BMI ≤ 39.9 kg/m2) and control group (31 subjects) of healthy normal women (18.5 ≤ BMI ≤ 24.9 kg/m2). An assessment of body mass index (BMI) was considered as a general obesity index and an assessment of waist circumference (WC) and waist to hip ratio (WHR) were considered as central obesity indices. A measurement of CC was considered for renal function. Results: The means of CC in subjects with increased BMI, WC, and WHR were significantly higher than those in subjects with normal BMI, WC, and WHR. Pearson correlation coefficient revealed that there was a stronger correlation between CC with WC than with WHR and BMI (r = 0.4, P = 0.009; r = 0.4, P = 0.01 in the case and control groups, respectively). Conclusions: It is suggested that in clinical practice, WC can be used as a better predictor of CC than WHR and BMI in both normal and obese, healthy women.

Iran, a developing country with a population of approximately 71,000,000, is the most populous country in the Middle East and the 16th most populous in the world. Gross domestic product (GDP) per capita is US$8900 and total health expenditure is approximately 6% of GDP. The total number of end-stage renal disease (ESRD) patients reported by the Management Center for Transplantation and Special Diseases (MCTSD) was 32,686 in 2007, which denotes a prevalence of 466 per million population (pmp) in Iran. Considering the growth rate of 12%, the expected number of ESRD patients in 2010 is 40,000; incidence of ESRD is expected to be 63.8 pmp. These numbers are lower compared to developed countries, which may suggest poor referral and under-diagnosis of ESRD. In Iran at present, hemodialysis (HD) and renal transplantation are the most common renal replacement therapy (RRT) modalities, accounting for 47.7% and 48.8% of prevalent RRT patients respectively. Based on the Iran Dialysis Center report of 2001, approximately 1% of ESRD patients were being treated with continuous ambulatory peritoneal dialysis (CAPD); this number increased to approximately 3.5% (6.8% of total dialysis patients) in 2006. In the present article, reasons for underutilization of peritoneal dialysis (PD) and improvements in PD within the past 5 years will be reviewed.