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Introduction: The significant and immediate analgesic effect of Non-thermal CO2 Laser Therapy (NTCLT) as an efficient, safe, and innovative photobiomodulation (PBM) approach has been demonstrated in some painful oral lesions, such as recurrent oral aphthous ulcers, oral lesions of pemphigus vulgaris, and oral mucositis due to chemotherapy of solid tumors. Case Presentation: We report a case of a kidney recipient patient hospitalized due to pancytopenia, fever, and painful oral ulcers. According to the clinical features of the oral lesions and after extensive workups, drug-induced leucopenia, and the resultant leucopenia-induced oral ulceration were the most acceptable diagnoses for the patient. She was referred to our laser department for pain reduction of her painful oral ulcers by NTCLT. The CO2 laser (power: 1 watt) was irradiated through a thick layer of a completely transparent gel with very high water content while scanning the surface of the lesion with rapid circular motion of the defocused handpiece. Results and Conclusions: The pain of the patient's oral ulcer was relieved immediately and dramatically after NTCLT without any visible thermal side effects. The procedure was completely painless, and anesthesia was not required. The results of this report suggest that NTCLT can be considered a promising procedure for significant and instant pain relief of leucopenia-induced oral ulceration in kidney recipient patients without any thermal complications. [ABSTRACT FROM AUTHOR]

Background Little is known about the potential relationship of obesity, adipose tissue and novel adipokines with cardiometabolic risk factors in end-stage renal disease. Zinc-α2-glycoprotein (ZAG) and adipose triglyceride lipase (ATGL) are novel adipokines with proposed desirable effects on inflammation, and lipid and glucose metabolism. The aim of this study was to investigate serum concentrations of ZAG and ATGL, and the relationship of these adipokines with cardiovascular risk factors in normal weight (NW) and obese (OB) patients undergoing hemodialysis. Methods Patients with regular hemodialysis including 44 normal weight (18.5

Introduction. The aim of this systematic review and meta-analysis was to evaluate the efficacy-related events and adverse events of 2 different doses of everolimus in kidney transplant recipients. Materials and Methods. The Cochrane, PubMed, and Google Scholar databases were searched for randomized controlled trials published by the end of 2015 on the use of everolimus in kidney transplant recipients at doses of 1.5 mg/d and 3 mg/d. Two independent reviewers assessed the studies for quality and eligibility and extracted the data. The relative risk (RR) and 95% confidence interval (CI) for treated efficacy-related events and adverse events were collected to calculate pooled measures. Results. A total of 8 articles describing 7 randomized controlled trials (n = 2148 participants) were included in this study. The overall RR in adverse event outcomes was significantly in favor of the lower dose of everolimus (RR, 0.96; 0.95% CI, 0.93 to 0.99; P < .001). The overall risk of graft loss was lower with 1.5 mg/d of everolimus (RR, 0.76; 0.95% CI, 0.59 to 0.99; P = .04, I2 = 25.0%). There was no relationship between the rates of efficacy failure, biopsy-proven acute rejection, death, or loss to follow up outcomes in all the three follow-up times between the two doses of everolimus. Conclusions. The result of this systematic review and meta-analysis showed that the overall outcomes in adverse events and graft loss were better with everolimus, 1.5 mg/d, than with everolimus, 3 mg/d, when combined with other kidney transplantation medications. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this systematic review and meta-analysis was to evaluate the efficacy-related events and adverse events of 2 different doses of everolimus in kidney transplant recipients.Materials and Methods: The Cochrane, PubMed, and Google Scholar databases were searched for randomized controlled trials published by the end of 2015 on the use of everolimus in kidney transplant recipients at doses of 1.5 mg/d and 3 mg/d. Two independent reviewers assessed the studies for quality and eligibility and extracted the data. The relative risk (RR) and 95% confidence interval (CI) for treated efficacy-related events and adverse events were collected to calculate pooled measures.Results: A total of 8 articles describing 7 randomized controlled trials (n = 2148 participants) were included in this study. The overall RR in adverse event outcomes was significantly in favor of the lower dose of everolimus (RR, 0.96; 0.95% CI, 0.93 to 0.99; P < .001). The overall risk of graft loss was lower with 1.5 mg/d of everolimus (RR, 0.76; 0.95% CI, 0.59 to 0.99; P = .04, I2 = 25.0%). There was no relationship between the rates of efficacy failure, biopsy-proven acute rejection, death, or loss to follow up outcomes in all the three time follow-up times between the two doses of everolimus.Conclusions: The result of this systematic review and meta-analysis showed that the overall outcomes of adverse events and graft loss were better with everolimus, 1.5 mg/d, than with everolimus, 3 mg/d, when combined with other kidney transplantation medications. [ABSTRACT FROM AUTHOR]

Pruritus is a common and bothersome problem among uremic patients which negatively affects life quality and prognosis of the patient. Various factors are known to be involved in the development of pruritus. The aim of this study was to assess the frequency and the factors which may have relationship with uremic pruritus, especially bone mineral metabolism indicators. Current cross-sectional study was done on 99 hemodialysis patients. Having pruritus, its duration, severity and correlation with patient's laboratory data was evaluated. For each patient a questionnaire was filled. The mean age of patients was 55.9±15.4 (23-87) years and 35.7% were female. They were on hemodialysis for 74.79±75.04 months. Frequency of pruritus was 58.6% (58 patients). Considering the severity, 16.2% suffered from severe pruritus, measured by visual analogue scale (VAS). Pruritus was more common in those on dialysis for more than 2 years (0.014). 82.8% of those with VAS of less than 3, in comparison with 37.5% of those with VAS of greater than 7, had no complaint of awakening due to pruritus. The frequency of pruritus and its severity was more in patients with higher serum phosphorus level (P=0.048). It seems that phosphate control which is not mainly attributed to dialysis adequacy and efficiency, needs more attention not only by medical team but also by patient. Decreasing the phosphate content of regimen may be cheap and helpful modality in pruritus management. [ABSTRACT FROM AUTHOR]

Organ shortage for transplantation remains a worldwide serious problem for kidney patients with end-stage renal failure, and several countries have tried different models to address this issue. Iran has 20 years of experience with one such model that involves the active role of the government and charity foundations. Patients with a desperate demand for a kidney have given rise to a black market of brokers and other forms of organ commercialism only accessible to those with sufficient financial resources. The current Iranian model has enabled most of the Iranian kidney transplant candidates, irrespective of socioeconomic class, to have access to kidney transplantation. The Iranian government has committed a large budget through funding hospital and staff at the Ministry of Health and Medical Education by supporting the brain death donation (BDD) program or redirecting part of the budget of living unrelated renal donation (LURD) to the BDD program. It has been shown that it did not prevent the development and progression of a BDD program. However, the LURD program is characterized by several controversial procedures (e.g., confrontation of donor and recipient at the end of the evaluation procedure along with some financial interactions) that should be ethically reviewed. Operational weaknesses such as the lack of a registration system and long-term follow-up of the donors are identified as the 'Achilles heel of the model'. [ABSTRACT FROM AUTHOR]

Abstract- Pattern of the coronary artery disease (CAD) risk factors across body mass index (BMI) categories remains uncertain. There is a different threshold of obesity for increasing cardiovascular hazard across populations, accordingly recognition and management of obesity and overweight can guide better control of CAD epidemic in the national level. To determine the discrepancy in the prevalence of CAD risk factors across five BMI categories. A population based survey of 28566 participants recruited to medical screening of taxi drivres in Tehran (MSTDT) was designed. According to a standardized protocol data on CAD risk factors were obtained by taking medical history, examination and laboratory tests. After adjustment for age, sex, literacy, smoking, systolic blood pressure (SBP), fasting blood sugar (FBS), and LDL-C/HDL-C ratio, these CAD risk factors of diastolic blood pressure (DBP)>90 mmHg, hypertriglyceridemia, high triglyceride/ HDL-C ratio, hypercholesterolemia, and high cholesterol/HDL-C ratio were increased significantly across five incremental categories of BMI. Prevalence of DBP> 90 mmHg, hypertriglyceridemia, hyper cholesterolemia and ratios of cholesterol/ HDL-C and TG/HDL-C increased considerably across five groups of BMI. This pattern is different from previous research and our results endorsed more features of pattern of CAD risk factors across BMI categories. [ABSTRACT FROM AUTHOR]

Background: Despite improvement in hepatitis B infection prevention through national vaccination programs, implementation of compulsory and thorough blood donor screening, and reduction of transfusion numbers due to erythropoietin administration, hepatitis B remains a major concern in hemodialysis (HD) centers (1). Compared to a response rate of over 90% in the normal population, only 50 to 60% of those with endstage renal disease (ESRD) achieve protective antibody levels following immunization against hepatitis B (2, 3). Various strategies have been developed to overcome the low seroconversion rate in ESRD patients, including co-administering zinc, gamma-interferon, thymopentin, interleukin-2, and levamisole as immunostimulants or adjuvants (3, 4), changing the injection mode (intradermal versus intramuscular), or doubling the vaccine dose (5). Objectives: Previous studies demonstrated that renal failure patients benefit from HBV vaccination; however, not all studies have demonstrated this. Therefore, we compared the rates of seroconversion (hepatitis B surface antibody [HBsAb] titer > 10 IU/mL) in patients at various stages of chronic kidney disease (CKD) (estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m2) who received HBV vaccination. Patients and Methods: A total of 167 patients in 3 different stages of CKD were vaccinated against HBV. Each patient received the vaccine according to a standardized vaccination schedule consisting of 40 μg of the recombinant vaccine "Engerix" at 0, 1, and 6 months. Eight to 12 weeks after the last dose of vaccination, anti-HBsAb levels were measured. Results: Mean age and eGFR were 57.4 ± 16.5 years and 26.7 ± 14.7 mL/min/1.73 m2, respectively. The overall seroconversion rate was 78%. Although a significant correlation between HBsAb titer and eGFR (r = 0.265, P = 0.001) was observed, in the multivariate analysis using age, CKD stage, diabetes mellitus, and gender as independent variables, the degree of renal function did not significantly contribute to seroconversion. In contrast, higher age (> 60 years) showed a significant negative correlation to seroconversion (odds ratio = 0.22; P = 0.004). Conclusions: CKD patients of advanced age should be vaccinated against HBV. Although higher eGFR was not associated with improved seroconversion, the persistence of seroconversion was not evaluated; future studies should be conducted to develop recommendations for earlier or later vaccination. [ABSTRACT FROM AUTHOR]

Abstract: Background: Developing current evidence in order to better assess the rates and pattern of the CAD risk factors among populations is pivotal in CAD risk stratification. Methods: A large scale population based survey involving 31,999 healthy people was designed. Risk factors information was provided from medical history, physical examination and laboratory assessments. Results: Increasing linear trend was observed for: cigarette smoking (CS) (P=0.001), systolic blood pressure (SBP)>140mmHg (P=0.001), diastolic blood pressure (DBP)>90mmHg (P=0.001), SBP>120mmHg (P=0.001), DBP>80mmHg (P=0.001), fasting blood glucose (FBS)>126Mg/dl (P=0.001), total cholesterol (TC)>200Mg/dl (P=0.001), triglyceride>200Mg/dl (P=0.001), TC>170Mg/dl (P=0.001), and LDL-c>130Mg/dl (P=0.001). Multivariable adjusted magnitudes of associations for risk factors across age groups were statistically different, thus in an age group of 30–40years: cigarette smoking, high DBP, increased body mass index (BMI), high level of FBS and lower level of education demonstrated strongest associations. In an age group of 40–50years: CS, high level of DBP, increased BMI, FBS>126Mg/dl, and SBP>120mmHg, in an age group of 50−60years: SBP>120mmHg, CS, higher level of DBP, and FBS>126Mg/dl, and in above 60years: SBP>120mmHg, HDL-c<45Mg/dl, C/S and FBS have demonstrated the strongest associations. Conclusions: Trends of increment in the mean levels of SBP, DBP, TC, LDL-c and FBS are statistically significant across age decades. Multivariate strength of associations for CAD risk factors demonstrates significant differences across age groups. [Copyright &y& Elsevier]

More than eighty percent of patients with coronary heart diseases (CHD) have conventional risk factors. Prevalence of well known risk factors seems to show a different pattern in younger patients and individual above 55 years. To evaluate the pattern of conventional CHD risk factors in healthy individuals in two different age groups. A large scale population based survey of 31999 individuals from ten medical centers was designed. Screening of risk factors was performed upon these protocols: taking medical history, physical examination and blood tests of complete blood cell counts, fasting blood sugar, lipid profile, urinalysis and creatinine. Prevalence of the risk factors in healthy people aged above 55 years were: 8.1% for systolic blood pressure (SBP)>140 mmHg, 3.8% for diastolic blood pressure (DBP)>90mmHg, 13.9% for fasting blood glucose (FBS)≥126 Mg/dl, 36.9% for total cholesterol>200 Mg/dl, 19.2% for triglyceride (TG)>200 Mg/dl, 67.8% for HDL-c<40 Mg/dl, 27.2% for LDL-c>130 Mg/dl, 4.72 for TC/HDL-c ratio, 2.88 for LDL-c/HDL/c ratio and 4.24 for TG/HDL-c ratio. Prevalence of risk factors in individuals younger than 55 years were: 1.7% for SBP>140 mmHg, 1.2% for DBP>90 mmHg, 5.2% for FBS≥126 Mg/dl, 31.3% for TC>200 Mg/dl, 21.5% for TG>200 Mg/dl, 69.4% for HDL-c<40 Mg/dl, 23.2% for LDL-c>130 Mg/dl, 4.7 for TC/HDL-c ratio, 2.83 for LDL-c/HDL-c ratio and 4.43 for TG/HDL-c ratio. In univariate model of analysis: prevalence of the risk factors were significantly higher in age above 55 years than in people younger than 55 years except for hypertriglyceridemia and HDL-c<40 Mg/dl. In a multivariate model of logistic regression, pattern of following CHD risk factors remained to demonstrate a statistically significance difference between two age groups: FBS≥126 Mg/dl P=0.006, TG>200 Mg/dl P= 0.002, HDL-c<40 Mg/dl P= 0.019, education status P=0.001, sex P=0.012, and SBP>140 mmHg P=0.001. Pattern of such a CHD risk factors of FBS≥126 Mg/dl, TG>200 Mg/dl, HDL-c<40 Mg/dl, education status, sex and SBP>140 mmHg demonstrated a statistically significant difference in the age above 55 years to the healthy people younger than 55 years. These results cab be implicated to set up prediction models for stratifying individuals at higher risk of CHD. [ABSTRACT FROM AUTHOR]

Dialysis and transplantation are life-saving but very expensive treatments. Current increases in the number of hemodialysis centers, machines, shifts, and kidney transplantations cannot keep pace with the increasing number of end-stage renal disease patients globally. The only way to decrease the incidence of end-stage renal disease is identifying patients with low glomerular filtration rate. The risk groups to be targeted, the expected outcomes, and the tests to be ordered are reviewed in this article. The ways that it is possible to make a screening program sustainable and likely cost-efficient model is discussed. It seems the high-risk target population for chronic kidney disease screening in our country can be those with diabetes mellitus, hypertension, hyperlipidemia, age over 40 years, and obesity (possibly abdominal obesity). Macroalbuminuria check in addition to serum creatinine measurement in high-risk population may look a practical approach to initiate a national program. [ABSTRACT FROM AUTHOR]

The article offers information on a case study conducted by the Iranian Journal of Kidney Diseases (IJKD) about a 48-year-old woman who was admitted after kidney transplantation due to acute allograft dysfunction. It states that the old lady underwent a 2 months hemodialysis before transplantation because of kidney failure brought by autosomal dominant polycystic kidney disease. It notes that cyclosporine, mycophenolate mofetil, and prednisolone were the immunosuppressive drugs that were used. Polycytic kidney and a manifestation of antibody-mediated rejection (AMR) were the primary causes of her end-stage renal disease where in a biopsy was done for the diagnosis. The biopsy specimen inferred that there is an endocapillary proliferation and local obliteration of capillary lumens.

Background and objectives. The rapid increase in end stage renal disease (ESRD) prevalence, plus the enormous cost of treatment, necessitates an urgent approach to implement strategies to prevent development and progression of ESRD, especially in the developing world. Screening that leads to early identification and treatment has been recommended, as it may slow or prevent progression to a more expensive and disabling stage of the disease and thus may save lives as well as finite resources. Methods. In 2007, the Healthy City Office of Tehran municipality conducted a large-scale population-based cross-sectional survey titled “Kidney Disease Screening of Taxi Drivers in Tehran.” Taxi drivers or applicants of purchasing taxi participated in mentioned screening program in the last three months of 2007. Demographic data, blood pressure, and history of hypertension or smoking—and then in specific laboratories creatinine, lipid profile, complete blood count, fasting blood sugar, and urinalysis—have been checked. Results. The survey covered 31,999 people across Tehran (in a population of 12 million) during the study period. The mean and SD of age of participants was 43.77 ± 11.32 (range from18 to 86) years, and 98.4% (31,489) were male. Using the MDRD equation, overall prevalence of eGFR <60 mL/min/1.73 m2 was 6.5%. However, the prevalence was 6.4% (1982/30949) in males in relation to 13.7% (69/503) in females. Mean and SD of BMI in males and females were 25.90 ± 3.91 and 26.48 ± 4.50 g, respectively. The overall prevalence of proteinuria (≥1+ proteinuria) was 0.6% in males vs. 1.8% in females in normal GFR group. Age, LDL cholesterol, hypertension, blood glucose, and BMI showed to be strong risk factors for low GFR. Education level did not show a significant correlation with low GFR. Discussion and conclusions. The findings of the study insist on the fact that CKD prevalence is significantly higher in old age, females, hypertensives, and uncontrolled diabetic patients. Our ability to decrease the incidence of ESRD is predicated on recognizing those patients with CKD and implementing all preventive strategies. [ABSTRACT FROM AUTHOR]

Introduction. The rapid increase in the prevalence of end-stage renal disease (ESRD) necessitates putting into practice some strategies to prevent its development and progression, especially in the developing world. Detailed chronological changes in the incidence of ESRD may sharpen the focus on its prevention. We, therefore, determined the detailed epidemiological features of ESRD in Iran. Materials and Methods. Data of the national registry of Iran's ESRD provided by the Ministry of Health were used to retrieve the ESRD figures between 1997 and 2006. Results. A total of 35 859 patients who initiated renal replacement therapy (20 633 men and 15 226 women) were registered during the study period from 1997 to 2006. The annual number of patients with ESRD beginning maintenance treatment in Iran increased 130% between 2000 and 2006. During 1997 to 2006, the proportion of new cases of ESRD attributed to diabetes mellitus increased 2-fold from 16% in 1997 to 31% in 2006. The mean age of newly registered men and women increased from 47.0 years and 49.0 years to 52.5 years and 53.0 years, respectively. As for all and major causes of ESRD, age-adjusted incidence rates for men generally were higher than those for women. Male-female ratio was 1.3:1, with no significant changes during this period. Conclusions. We strongly recommend considering chronic kidney disease prevention with initial focusing on strategies and treatment modalities that slow ESRD progression in order to postpone the need for renal replacement therapy. [ABSTRACT FROM AUTHOR]

Introduction. Living unrelated kidney donation has a high rate in Iran, where a unique organ procurement model is running. We evaluated feelings and attitude of these donors after kidney donation. Materials and Methods. A questionnaire was sent to 25 kidney transplantation centers in Iran. It was designed to assess kidney allograft donors in terms of their reason for donation, their feeling after donation, and their attitude on keeping in touch with the recipients. Of 721 donors recorded in the national registry during the study period, we collected data of 600 living donors and their answers to the questionnaire. Results. Of 600 donors, 495 (82.5%) were men and 568 (94.8%) were unrelated to the recipients. Motivation for donation was stated to be purely financial by 224 respondents (37.3%) and purely altruistic by 11 (1.9%). Their feelings before discharge were complete satisfaction in 519 (86.5%), relative satisfaction in 69 (11.5%), regret in 9 (1.5%), and indifference in 3 (0.5%). Willingness to get informed of the transplant outcome and make connection with the recipient following transplantation was chosen by 457 (76.2%) and 400 (66.7%) donors, respectively. Conclusions. We found that satisfaction of donors shortly after donation, on the one hand, and no reportedly serious complications in long-term follow-up of donors, on the other hand, may give the impression that the Iranian model may solve the problem of increasing demand for kidney allograft. Nevertheless, every country should build its own standards for living unrelated kidney donation consistent with its capacities and resources. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the health service cost of hemodialysis (HD) delivered at hospitals in Iran as a developing country with a well-defined program of renal replacement therapy. A cost analysis was performed from the viewpoint of the 2 hospitals, with 3 shifts and full chairs, on current practice for dialysis maintenance. Cost and patient data were collected in 2006 and from April 1 to May 31, 2007, respectively. A total of 22,464 HD sessions were performed and 247 patients were studied during the study period. The reference year for the value of USD for different mentioned costs was 2006. Health care sector costs associated with each HD session were estimated at US$78.87. Most of the total maintenance expenditure was made up of medical supplies (36.19%), with dialyzers as the major cost driver. Staff salaries represented 17% of the cost and fixed direct capital costs accounted for 21.4%. Of the family members, 32.4% accompanied their patients. The mean cost for transportation of patients and accompanied person was US$3.15 ± 2.83 and US$1.5 ± 0.29, respectively. These findings are important in the light of limited available resources coupled with the increasing prevalence of kidney failure. A major attempt should also be made to increase peritoneal dialysis coverage as in some centers we cannot keep all chairs full, especially in some vast areas. It is highly recommended to place initial focus on strategies and treatments that slow disease progression, to postpone renal replacement therapy to save resources. [ABSTRACT FROM AUTHOR]

Introduction. Glomerular Filtration Rate (GFR) is the main tool to assess kidney function. Some experts suggest cystatin C as a more precise and accurate indicator than creatinine to calculate GFR. This study is designed to assess if cystatin C is more helpful in early diagnosis and better follow-up of Chronic Kidney Disease (CKD) patients who may benefit more from appropriate and timely management. Methods. We studied 312 patients in different stages of CKD and normal kidney function as control. GFR based on creatinine (Jaffe and enzymatic) and cystatin C were calculated and compared. Results. A total of 146(46.8%) patients were male with a mean age of 53±17.5 years. The patients were divided into 3 groups based on GFR (>60 cc/min/1.73m², 30< GFR<60cc/min/1.73m², 15

A letter to the editor is presented regarding the contribution of technology in preventing non-communicable diseases (NCD).

The author discusses aspects of the traditional diagnostic methods of nephrology that have been replaced with more sophisticated procedures which put more reliance on laboratory personnel than on nephrologists. He cites a study that compares the beneficial results from urine analysis by a nephrologist compared to a hospital-based clinical laboratory. The author suggests the reintroduction of urine analysis into clinical practice and nephrology education.

The author discusses aspects of glomerulopathies that cause end-stage renal diseases in younger populations in Iran which call for different treatment options to prevent outcomes. He cites studies that compare steroid-resistant nephrotic syndrome (SRNS) and steroid-sensitive nephrotic syndrome related to gene mutations in idiopathic nephrotic syndrome. The author believes that histologic features and clinical findings do not differentiate genetic mutations which may require more studies.

A letter to the editor is presented in response to the article "Risk Factors for Contrast-related Acute Kidney Injury According to Risk, Injury, Failure, Loss, and End-stage Criteria in Patients With Coronary Interventions" in the April 2010 issue.

Introduction: Mineral and bone disorders are common in patients with chronic kidney disease (CKD). Vitamin D plays an important role in calcium-phosphorus balance. Objectives: The main aim of this investigation is to assess the relation between circulating levels of 25(OH) vitamin D and parathyroid hormone (PTH) and estimating the best threshold of vitamin D which may prevent secondary hyperparathyroidism. Patients and Methods: This cross-sectional study was conducted between January 2014 to September 2015. Adult patients with CKD who were not on routine peritoneal dialysis or hemodialysis and did not receive any kidney transplantation, enrolled to this study. Patients who were pregnant or who were on vitamin D supplementation therapy were excluded. Basic demographic and laboratory information were measured. Results: Around 254 patient enrolled in this study (55.1% men). The prevalence of vitamin D deficiency and insufficiency were significantly high, 12.6% and 53.9%, respectively. Serum PTH level increased significantly as circulating plasma level of 25(OH) vitamin D decreased (P = 0.003). Serum total calcium increased significantly with high levels of plasma 25(OH) vitamin D (P < 0.001) and hypercalcemia was seen in 2.8% of patients. Piecewise linear regression modeling of PTH for 25(OH) vitamin D estimated the best threshold for 25(OH) vitamin D of 13.00 ng/mL (95% CI: 2.55-23.44 ng/mL) (P = 0.015). Conclusion: This study again confirms this fact that sufficient level of serum 25(OH) vitamin D is mandatory in patients with CKD in order to prevent secondary hyperparathyroidism. Although this study recommends level of serum 25(OH) vitamin D to be above 13 ng/mL for this purpose. [ABSTRACT FROM AUTHOR]

Background Protein-energy wasting is a prevalent disorder in haemodialysis. Zinc-α2-glycoprotein ( ZAG) and adipose triglyceride lipase ( ATGL) are novel adipokines with recognized lipolytic effects and proposed role in metabolic homoeostasis. This study was conducted to investigate the association of ZAG and ATGL concentrations with malnutrition-inflammation score ( MIS) and metabolic profile of patients with haemodialysis. Materials and methods Eighty-eight patients under regular haemodialysis were divided based on MIS to normal to mild wasting ( NMW; n = 35) or moderate wasting ( MW; n = 53) group. Anthropometric measurements along with fasting serum concentrations of ZAG, ATGL, free fatty acids ( FFAs), albumin, transferrin, total iron-binding capacity ( TIBC), hs- CRP, lipid profile and glucose metabolism were assessed. Results Adipose triglyceride lipase concentration was significantly higher in MW than NMW group (10·89 ± 5·7 vs. 8·02 ± 3·37 mIU/ mL; P = 0·008). The ZAG and FFAs were not significantly different between two groups. ATGL was directly correlated with FFAs in all of the patients ( r = 0·284, P = 0·007) and MW ( r = 0·32, P = 0·021), and marginally in NMW ( r = 0·31, P = 0·057) groups. ATGL and odds of having mild or moderate wasting were significantly correlated (OR = 1·21, P = 0·033). A positive association was observed between ATGL with TG ( r = 0·31, P = 0·049) and also with transferrin and TIBC ( r = 0·44, P = 0·001) only in MW group. An inverse relationship was observed between ATGL and HDL in all of the participants ( r=−0·222, P = 0·04). No significant correlation was observed between ZAG and other parameters. Conclusions The serum concentrations of ATGL, but not ZAG, were significantly higher in MW compared to NMW group. Each unit increase in ATGL concentrations was correlated with 21% increase in the odds of wasting severity. ATGL might play a role in wasting pathogenesis and metabolic profile in haemodialysis. [ABSTRACT FROM AUTHOR]

Aim Protein-energy wasting ( PEW) is prevalent in haemodialysis. Obesity is an independent risk factor of kidney insufficiency, but it is proposed to have beneficial roles in better outcomes in the final stage of disease. Better nutritional status and body reserves are among probable mechanisms, but direct examinations are limited. The present study aimed to investigate whether obese patients have preferable nutritional status compared to normal weight patients based on malnutrition inflammation score ( MIS) and other PEW parameters in haemodialysis. Methods This case-control study investigated 52 normal weight (18.5 < body mass index ( BMI) < 25 kg/m2) and 48 obese ( BMI≥30 kg/m2) patients on regular haemodialysis. PEW was assessed based on anthropometric and biochemical factors, recent weight changes, appetite, anorexia, dietary intake and MIS. Results Obese patients had better MIS compared with the normal weight group ( P < 0.001), although varying degrees of wasting were prevalent among this group too (75% mild and 25% moderate wasting). The obese group had less significant weight loss (4.2 vs 8%) and anorexia and better appetite. However, a considerable percentage of patients in both groups showed muscle (94.6% of normal weight and 19.5% of obese) and peripheral fat tissue (89.2% of normal weight and 31.7% of obese) losses compared to the 50th percentile. Biochemical parameters were not significantly different between groups except for triglyceride ( P = 0.001), transferrin and total iron-binding capacity ( P = 0.028). Conclusions MIS was significantly better in obese patients; however, both groups showed degrees of wasting based on MIS and other PEW parameters. Nutritional status of obese haemodialysis patients should be monitored regularly because of high risk of PEW like other BMI categories. [ABSTRACT FROM AUTHOR]

Tissue transplantation is a life-enhancing therapeutic modality for damaged or non-functioning tissues. In most cases, there is no alternative other than human tissue as replacement, and taking into account the ever-increasing demand for tissue grafts, it makes sense to set up an establishment in charge of human tissue procurement to meet local needs. A quality assurance system, clearly defined standards, and regular audits complement the infrastructure which make this activity feasible. The process of tissue procurement consists of donor identification, consent, tissue recovery, donor screening and testing, tissue processing, preservation, packaging, labeling, terminal sterilization, storage and distribution. The transplantation of homograft heart valves remains controversial, due to the availability of prosthetic and bioprosthetic alternatives. The limited durability of homografts has not yet outweighed the advantages which this graft offers. Adherence to regulations and regularly revised guidelines improve long-term efficacy and minimizes complications or malfunction. Furthermore, the lower price of homograft heart valves and the removal of the need for a lifetime of anticoagulation therapy are noteworthy advantages of this replacement. In our practice, the proportion of homograft heart valves meeting release criteria and successfully implanted grafts were 83% and 95%, respectively. [ABSTRACT FROM AUTHOR]

Abstract: This study assessed the added effect of 6 months of erythropoietin (EPO) administration in patients suffering from diabetic neuropathy with mild to moderate chronic kidney disease (CKD) managed with gabapentin. Twenty diabetic patients with mild to moderate CKD were included; 12 in gabapentin and 8 in EPO+gabapentin group. The subjects underwent nerve conduction studies (NCS) at the initiation of the investigation and after 6-month treatment. NCS were made in deep and superficial peroneal, tibial, and sural nerves. After 6 months, in both the groups, proximal motor latency (PML) nonsignificantly improved in deep peroneal and tibial nerves; conversely, dorsal motor latency (DML) got slightly impaired in these two nerves. A nonsignificant disruption and improvement was observed in deep peroneal and tibial motor nerve conduction velocity (MNCV), respectively, in gabapentin group. Although the F-wave of tibial and deep peroneal nerves remained stable in gabapentin group, a nonsignificant improvement was observed in EPO+gabapentin group. H-reflex of tibial nerve and all the evaluated parameters of sural and superficial peroneal nerves remained constant in all patients. Thus, it can be concluded that 6-month administration of EPO+gabapentin, or gabapentin alone in mild to moderate CKD patients with diabetic neuropathy could not improve nerve performance. [Copyright &y& Elsevier]

Hepatitis B (HBV) and C (HCV) viruses are the most important infections transmitted by the parenteral route in patients receiving maintenance dialysis. The prevalence varies markedly from country to country. The aim of this study is to review the efficacy of the strategies to reduce the incidence of these infections and the trend of results in Iran. As a routine, all hemodialysis patients in Iran have biannual blood samples for assessment of serum HBSAg, HBS Abs, and HCV Abs. The data are collected in the Ministry of Health. For statistical analysis, prevalence, and incidence were calculated. There is an increasing prevalence/incidence of end-stage renal disease (ESRD) in Iran, from 238/49.9 pmp in 2000 to 357/63.8 pmp in 2006. The prevalence of positive HBSAg and HCV Abs decreased from 3.8% and 14.4% in 1999 to 2.6% and 4.5% in 2006, respectively. Regarding the genotype distribution in Iran, no one was found with genotype 2. On the subject of decreasing HBV infection, our next strategy should be mandatory vaccination in dialysis centers and in the pre-ESRD period. Concerning HCV infection prevention, 2 approaches may be recommended: the first is decrease of duration of the hemodialysis period by possible early transplantation of suitable patients. The next is a strictly enforced isolation policy for HCV-positive patients, which may play a role in limiting HCV transmission in HD units, and universal precaution in dialysis units should be under constant close surveillance. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding the estimation of brain death of organ donors in Iran.

Aim: To bridge the gap in the current knowledge, the present study was conducted to obtain evidences relating to clinical outcomes of the end-stage renal disease (ESRD) population in Iran over the last two decades. Methods: The records of 84 652 incident ESRDpatients from1995 up to and including 2014 in the national registry of ESRDpatientswere analyzed retrospectively. Data were collected from dialysis and transplant centres in Iran from 1995 to 2008 via paper forms and from2009 to 2014 throughweb-based records. Results: Mean age (SD) in incident cases of ESRD (57.7% male) was 52.5 (16.6) years. The prevalence of ESRDpatients grew on average 14.9%and 5.3%annually in the periods of 1995-2004 and 2005-2014, respectively. Adjusted mortality rate among dialysis patients in 1995, 2005, and 2014 was 145, 154, and 177/1000 patient-years, respectively. Median graft half-life (IQR) and median expected remaining life-years (IQR) for dialysis patients in the 2003 incident patient cohort were 4.4 (1.9-8.3) and 4.2 (1.8-8.2) years, respectively. Conclusions: The overall slightly decreasing, and still comparable, survival trend in dialysis patients, despite the accessible and free dialysis treatment, may be the result of the counterbalance of different contributory factors, including increased age and the higher proportion of patients with comorbidities resulting from diabetes and hypertension. The half-lives of renal allografts were generally shorter compared to thus far shared evidence, which may be due to tissue incompatibility. The decreasing trend, in this context, can be attributable to the increased number of transplantation from deceased donors with expanded criteria. [ABSTRACT FROM AUTHOR]

Low vitamin D levels have been linked to metabolic syndrome in the general population. In the present study, the relationship between inadequate serum concentrations of vitamin D and metabolic syndrome in patients with end-stage renal disease undergoing hemodialysis was explored. In a cross-sectional setting, 145 patients undergoing maintenance hemodialysis were enrolled. Metabolic syndrome was defined using the International Diabetes Federation criteria. Serum concentration of 25(OH) vitamin D was determined by a commercially available enzyme immunosorbent assay method. The prevalence of metabolic syndrome was 53.1%. The prevalence rate of severe vitamin D deficiency (<5 ng/mL) was 3.4%, mild vitamin D deficiency (5-15 ng/mL) 31.0%, vitamin D insufficiency (16-30 ng/mL) 36.6%, and vitamin D sufficiency (>30 ng/mL) 29.0%. With the increasing number of metabolic abnormalities, vitamin D levels significantly decreased (P for trend = 0.028). Among the components of metabolic syndrome, vitamin D deficiency was significantly associated with central obesity (odds ratio [OR], 95% confident interval [CI] = 2.80, 1.11- 7.04, P = 0.028). A positive, but nonsignificant association between vitamin D deficiency and raised fasting plasma glucose was noted (OR, 95% CI = 2.40, 0.94-6.11, P = 0.067). Both vitamin D deficiency and insufficiency were significantly associated with an increased likelihood of having metabolic syndrome (P < 0.05). In a final model controlling for age, sex, and parathyroid hormone levels, vitamin D deficiency increased the odds of having metabolic syndrome by more than threefold (OR, 95% CI = 3.26, 1.30-8.20, P = 0.012). Low levels of vitamin D are frequent among hemodialysis patients and are associated with the metabolic syndrome. [ABSTRACT FROM AUTHOR]

Background: Everolimus is an immunosuppressive agent with a novel mode of action but has a different clinical role with calcineurin inhibitors (CNI). The aim of this study was to evaluate the safety and effectiveness of everolimus compared with sirolimus and tacrolimus in preventing kidney transplantation rejection. Methods: Search was conducted for finding randomized clinical trials (RCT) until the end of 2013 in main databases include Cochrane, Medline and other related databases in February 2014. To find the ongoing trials two databases were searched (Clinicaltrial. gov and irct.ir/fa/). Two independent reviewers checked studies for quality and eligibility and finally extracted the data. Data extraction was performed using Cochrane data extraction form for clinical trial. Discrepancies were resolved via consultation with third person. The studies examined in term of heterogeneity with I2 and Chi-square test. The mata-analysis was carried out using RevMan 5.2 (Wintertree Software Inc, Ontario, Canada) when there was homogeneity. Results: Finally, seven reports from six RCTs included in this study. All reports were in english language and total numbers of participant in these studies were 824. No studies were found in comparison of everolimus and sirolimus and all seven reports were combination of everolimus, tacrolimus and other relative drugs. Follow up time of studies were different from 6 to 36 months. Due to the heterogeneity of included studies, only two studies were entered into meta-analysis. The recorded mean values for glomerular filtration rate, serum creatinine and creatinine clearance were between 60-80 ml/min, 50 to 80 ml/min and 1.2 to 1.9 mg/dl respectively. The results of meta-analysis in three outcomes include; serum creatinine, creatinine clearance and glomerular filtration rate were significantly in favor of low dose tacrolimus plus everolimus. Conclusion: In general, everolimus showed better results in combination with tacrolimus. Given the available evidence in this study, everolimus in combination with low dose tacrolimus showed better safety and effectiveness in preventing kidney transplantation rejection. [ABSTRACT FROM AUTHOR]

Background: This study was designed to investigate the associations between malnutrition-inflammation score (MIS), dialysis-malnutrition score (DMS) and serum albumin with novel risk factors for cardiovascular diseases (CVD) in hemodialysis (HD) patients. Methods: In this cross-sectional study, 291 HD patients were randomly selected from among 2302 adult HD patients in Tehran HD centers. The MIS and DMS were determined during one of the dialysis sessions in these patients. In addition, 4 mL blood was obtained before dialysis and analyzed for serum albumin and novel risk factors for CVD, including C-reactive protein (CRP), soluble intercellular adhesion molecule type 1 (sICAM-1), soluble vascular cell adhesion molecule type 1 (sVCAM-1), sE-selectin, malondialdehyde (MDA), nitric oxide (NO), endothelin-1 and lipoprotein (a) [Lp (a)]. Results: MIS and DMS were significantly positively correlated with serum CRP ( p < 0.01) and sICAM-1 ( p < 0.01), whereas serum albumin concentration was significantly negatively correlated with serum CRP ( p < 0.01) and sICAM-1 ( p < 0.01). There were no significant correlations between MIS, DMS and serum albumin with serum concentrations of sVCAM-1, sE-selectin, MDA, NO, endothelin-1 and Lp (a). Conclusion: This study indicates that protein-energy wasting indicators in HD patients are associated with serum CRP and sICAM-1, as two CVD risk factors. [ABSTRACT FROM AUTHOR]

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 <60 mL/min/1.73 m2. Results In individuals with cumulative stone size <20 mm, estimated glomerular filtration rate significantly decreased when moving from the first (estimated glomerular filtration rate 75.5 ± 17.8 mL/min/1.73 m2) to the fourth (estimated glomerular filtration rate 56.4 ± 20.44 mL/min/1.73 m2) quartile ( P = 0.004). When patients with a cumulative stone size ≥20 mm were included, the observed association was rendered non-significant. In individuals with a cumulative stone size <20 mm, each 1-mm increase in cumulative stone size was associated with a 20% increased risk of having chronic kidney disease. The relationship persisted even after adjustment for age, sex, body mass index, C-reactive protein, fasting plasma glucose, thyroid stimulating hormone, presence of microalbuminuria, history of renal calculi, history of extracorporeal shockwave lithotripsy, number and location of the stones (odds ratio 1.24, 95% confidence interval 1.02-1.52). The same was not observed for individuals with a cumulative stone size ≥20 mm. Conclusions In kidney stone formers with a cumulative stone size up to 20 mm, estimated glomerular filtration rate linearly declines with increasing cumulative stone size. Additionally, cumulative stone size is an independent predictor of chronic kidney disease in this group of patients. [ABSTRACT FROM AUTHOR]

Sagliker syndrome was introduced in 2004 in patients with end-stage renal disease and severe secondary hyperparathyroidism. This syndrome describes maxillary and mandibular deformities, dental abnormalities, benign soft tissue tumors in mouth, and various kinds of skeletal changes including short stature and fingertip abnormalities. There are a few reports from different regions of the world. The aim of this study is to report 5 cases of the Sagliker syndrome from Iran. [ABSTRACT FROM AUTHOR]

Introduction. Cardiovascular diseases are the most common causes of death in chronic kidney disease (CKD) and kidney transplant patients. This study aimed to evaluate cardiac troponins in transplant recipients and CKD patients without cardiac symptoms. Materials and Methods. Two groups of patients (CKD and kidney transplant recipients) were evaluated for troponins T and I levels. These values were associated with renal replacement therapy and demographic and clinical characteristics of the patients. Results. Eighty CKD patients and 80 kidney transplant recipients were studied. There was a significant difference in Troponins T and I levels were significantly higher in the CKD group than in the transplant recipients. In the CKD group, 14 patients (17.5%) had an elevated troponin T level and 8 (10.0%) had an elevated troponin I, all of whom were in stage 4 of CKD. None of the kidney transplant patients had a positive troponin. Among CKD patients, decreased glomerular filtration rate was associated with elevated troponin I level. Elevated troponin T level was significantly associated with age and decreased glomerular filtration rate. In multivariable analysis, significant associations were found between troponin T level and age, serum creatinine, and glomerular filtration rate. A significant relationship was also found between troponin I and cholesterol and glomerular filtration rate. Conclusions. The assessment of troponin T and I in CKD and kidney transplant patients shows that in patients with CKD and without any symptoms of acute coronary syndrome, serum level of cardiac troponins increase and it is linked to serum creatinine and GFR. [ABSTRACT FROM AUTHOR]

Sagliker syndrome was introduced in 2004 in patients with endstage renal disease and severe secondary hyperparathyroidism. This syndrome describes maxillary and mandibular deformities, dental abnormalities, benign soft tissue tumors in mouth, and various kinds of skeletal changes including short stature and fingertip abnormalities. There are a few reports from different regions of the world. The aim of this study is to report 5 cases of the Sagliker syndrome from Iran. [ABSTRACT FROM AUTHOR]

Introduction. Cardiovascular diseases are the most common causes of death in chronic kidney disease (CKD) and kidney transplant patients. This study aimed to evaluate cardiac troponins in transplant recipients and CKD patients without cardiac symptoms. Materials and Methods. Two groups of patients (CKD and kidney transplant recipients) were evaluated for troponins T and I levels. These values were associated with renal replacement therapy and demographic and clinical characteristics of the patients. Results. Eighty CKD patients and 80 kidney transplant recipients were studied. There was a significant difference in Troponins T and I levels were significantly higher in the CKD group than in the transplant recipients. In the CKD group, 14 patients (17.5%) had an elevated troponin T level and 8 (10.0%) had an elevated troponin I, all of whom were in stage 4 of CKD. None of the kidney transplant patients had a positive troponin. Among CKD patients, decreased glomerular filtration rate was associated with elevated troponin I level. Elevated troponin T level was significantly associated with age and decreased glomerular filtration rate. In multivariable analysis, significant associations were found between troponin T level and age, serum creatinine, and glomerular filtration rate. A significant relationship was also found between troponin I and cholesterol and glomerular filtration rate. Conclusions. The assessment of troponin T and I in CKD and kidney transplant patients shows that in patients with CKD and without any symptoms of acute coronary syndrome, serum level of cardiac troponins increase and it is linked to serum creatinine and GFR. [ABSTRACT FROM AUTHOR]

Background: Membranous glomerulonephritis (MGN) may cause proteinuria as the main complication and is a strong risk factor for end-stage renal disease. Current therapeutic regimens provide only partial renoprotection. Data derived from both animal and human studies provide a scientific basis for the use of pentoxifylline as an antiproteinuric agent. Objective: This study was designed to evaluate the antiproteinuric effect of add-on pentoxifylline therapy in non-diabetic patients with MGN. Study Design: This was a double-blind, placebo-controlled trial. Setting: Non-diabetic patients with histologically proven MGN and urinary protein excretion (UPE) >500 mg/24 h, entered a 6-month study period. Enrolled patients were selected from a university and three private clinics. Intervention: Patients were assigned to one of the two treatment groups: pentoxifylline 400 mg two or three times a day, or matching placebo. Main Outcome Measures: Baseline and follow-up assessments included estimated glomerular filtration rate (eGFR) and UPE. Differences in the changes in variables within the placebo and pentoxifylline treatment groups during the study period were assessed using Friedman's test. Results: Treatment with pentoxifylline for 6 months resulted in a significant reduction of mean UPE ( p < 0.001) along with a slight, non-significant increase of eGFR, in comparison to the mean UPE and eGFR increase in the placebo group. Conclusion: This study showed that add-on therapy of pentoxifylline in MGN was beneficial, and could be considered as a potential new therapeutic indication for the drug in such kidney diseases. [ABSTRACT FROM AUTHOR]

Background: This study was designed to determine the prevalence of protein-energy wasting (PEW) and its various types in hemodialysis (HD) patients in Tehran, Iran. Methods: For this cross-sectional study, 291 HD patients were randomly selected. The nutritional status of the patients was determined by subjective global assessment (SGA) and their dietary intakes were assessed using a 4-day dietary recall. In addition, serum high-sensitive C-reactive protein (hs-CRP) was measured. Results: The prevalence of mild-to-moderate and severe PEW based on SGA was 60.5% and 1% in Tehran HD patients, respectively. The prevalence of various types of PEW in HD patients was 20.5% type I (inadequate energy or protein intake without inflammation), 65.5% type IIa (inadequate energy or protein intake with inflammation), and 14% type IIb (adequate energy and protein intake with inflammation). Of the total HD patients with no PEW based on SGA, about 3.5% had type 0 normal nutritional status (adequate energy and protein intake without inflammation), 34% had type I normal nutritional status (inadequate energy or protein intake without inflammation), 55.5% had type IIa normal nutritional status (inadequate energy or protein intake with inflammation), and 7% had type IIb normal nutritional status (adequate energy and protein intake with inflammation). Conclusion: PEW in Tehran HD patients is considerably prevalent and PEW type IIa is the most common type. In addition, HD patients with no PEW based on SGA should also be paid attention because they may be in the early stages of inadequate intake of energy and/or protein and inflammation. [ABSTRACT FROM AUTHOR]

Inadequate dietary intakes are a major determinant of malnutrition in hemodialysis ( HD) patients. Considering the lack of information available on dietary intakes of HD patients in Iran, the present study was designed to assess the dietary intakes of HD patients in Tehran, Iran. For this cross-sectional study, from among adult HD patients of 50 Tehran hemodialysis centers, 291 patients were randomly selected. Dietary intakes of these patients were assessed using a 4-day dietary recall. In addition, 4 mL of blood was obtained from each patient before dialysis to measure serum urea, creatinine, albumin, phosphorus, calcium, potassium, and high sensitive C-reactive protein levels. Dietary intakes of energy, protein and fiber were lower than recommended intakes in 88%, 84.5%, and 99% of HD patients, respectively. There were significant associations between dietary energy intake with the patient's age ( p < 0.05), and HD vintage ( P < 0.001). In addition, a significant association was found between dietary protein intake and sex ( P < 0.05). Intakes of vitamins B1, B2, B3, B6, B12, C, E, folic acid, and of the minerals calcium and zinc (from both the diet and supplements) were lower than recommended intakes in 13.5%, 41.5%, 19%, 66%, 61%, 78%, 77%, 24%, 34%, and 98.5% of HD patients, respectively. Inadequate intakes of energy and various nutrients are prevalent in HD patients in Tehran, Iran, which may contribute to increased morbidity and mortality in these patients. Therefore, nutrition counseling and the administration of vitamin and mineral supplements are necessary in Iranian HD patients. [ABSTRACT FROM AUTHOR]