Publications by authors named "Shokoufeh Savaj"

24 Publications

  • Page 1 of 1

Angiotensin Converting Enzyme Inhibitors, A Risk Factor of Poor Outcome in Diabetic Patients with COVID-19 Infection.

Iran J Kidney Dis 2020 12 5;14(6):482-487. Epub 2020 Dec 5.

Firoozgar Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran.

Introduction: Diabetes mellitus and hypertension are described as the most common comorbidities among COVID-19 patients. We investigated the adverse effect of ACEIs in diabetic and nondiabetic patients with COVID-19.

Methods: This prospective study consisted of 617 RT-PCR-confirmed COVID-19 inpatients. Demographic and baseline characteristics, underlying comorbid diseases, and antihypertensive drugs were evaluated. Study outcome (in-hospital death) was evaluated with the Kaplan-Meyer method and Cox regression model. Statistical analyses were performed with SPSS software for Windows. P values < .05 were considered significant.

Results: Mean ± SD age was 58.49 ± 15.80 (range: 18 to 94) years old. Cox regression analysis revealed that age (adjusted hazard ratio [HR] = 1.04, 95% CI: 1.03 to 1.06), diabetes mellitus (adjusted HR = 2.07, 95% CI: 1.32 to 3.26), immunocompromised patients (adjusted HR = 2.33, 95% CI: 1.29 to 4.21), acute kidney injury (AKI) (adjusted HR = 3.23, 95% CI: 2.01 to 5.19), ICU admission (adjusted HR = 2.48, 95% CI: 1.46 to 4.21), Asthma and COPD (adjusted HR = 2.13, CI:1.6 to 4.28) and ACEI (adjusted HR = 3.08, 95% CI: 1.56 to 6.06), respectively were associated with in-hospital death. Among diabetic patients, ACEI (adjusted HR = 3.51, 95% CI: 1.59 to 7.75), AKI (adjusted HR = 3.32, 95% CI: 1.76 to 6.45) and ICU admission (adjusted HR = 3.64, 95% CI: 1.530 to 8.65) were associated with increased mortality. The Kaplan-Meier survival curve showed a lower survival rate in diabetic patients with ACE inhibitor (adjusted HR = 3.36, 95% CI: 2.25 to 7.71).

Conclusion: ACEIs may harm the diabetic patient's outcome with COVID-19. Further studies can confirm if ACE inhibitors have an adverse effect on COVID-19 diabetic patient's mortality.
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December 2020

SARS-CoV-2 Molecular and Phylogenetic analysis in COVID-19 patients: A preliminary report from Iran.

Infect Genet Evol 2020 10 30;84:104387. Epub 2020 May 30.

Department of Virology, Iran University of Medical Sciences, Tehran, Iran; Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran. Electronic address:

Background: The aim of the current study was to investigate and track the SARS-CoV-2 in Iranian Coronavirus Disease 2019 (COVID-19) patients using molecular and phylogenetic methods.

Methods: We enrolled seven confirmed cases of COVID-19 patients for the phylogenetic assessment of the SARS-CoV-2 in Iran. The nsp-2, nsp-12, and S genes were amplified using one-step RT-PCR and sequenced using Sanger sequencing method. Popular bioinformatics software were used for sequences alignment and analysis as well as phylogenetic construction.

Results: The mean age of the patients in the present study was 60.42 ± 9.94 years and 57.1% (4/7) were male. The results indicated high similarity between Iranian and Chinese strains. We could not find any particular polymorphisms in the assessed regions of the three genes. Phylogenetic trees by neighbor-joining and maximum likelihood method of nsp-2, nsp-12, and S genes showed that there are not any differences between Iranian isolates and those of other countries.

Conclusion: As a preliminary phylogenetic study in Iranian SARS-CoV-2 isolates, we found that these isolates are closely related to the Chinese and reference sequences. Also, no sensible differences were observed between Iranian isolates and those of other countries. Further investigations are recommended using more comprehensive methods and larger sample sizes.
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http://dx.doi.org/10.1016/j.meegid.2020.104387DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7832360PMC
October 2020

Effect of Angiotensin II Receptor Type 1 Antibodies on Kidney Allograft Function.

Iran J Kidney Dis 2018 03;12(2):120-122

Iran University of Medical Sciences, Tehran, Iran.

Introduction: Non-human leukocyte antigen antibodies are an independent risk factor for acute rejection in kidney transplant recipients. Among them, angiotensin II receptor type 1 (ART1) antibodies can induce various effects, but their clinical importance in kidney transplant recipients has not been properly explained. This study aimed to evaluate the effect of ART1 antibodies on allograft function and hypertension in stable kidney transplant recipients.

Materials And Methods: Eighty-one kidney recipients from non- human leukocyte antigen antibodies-matched donors with stable allograft function were examined for estimated glomerular filtration rate (Chronic Kidney Disease-Epidemiology Collaboration formula) and ART1 antibodies (measured using an enzyme-linked immunosorbent assay method). The result was considered positive if the anti-ART1 level was greater than 17 U/mL.

Results: The mean age of the participant was 51.1 ± 11.9 years with the mean time from transplantation was 83.5 ± 6.5 months. Fifteen recipients (18.5%) had a high ART1 antibodies level. Those with low titers of ART1 antibodies had better allograft function. The mean estimated glomerular filtration rate was 63.0 ± 13.7 mL/min in those with low ART1 antibodies and 42.3 ± 13.9 mL/min in those with high ART1 antibodies (P < .001). There were no significant correlation between high ART1 antibodies levels and hypertension, cause of end-stage renal disease, age, sex, transplant and dialysis duration, cytomegalovirus infection, antihypertensive medication, or immunosuppressive agents.

Conclusions: A high level of ART1 antibodies was a risk factor for allograft function; however this indicator was not correlated with hypertension in our study.
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March 2018

Irreversible Lesions of Tacrolimus-induced Posterior Reversible Leukoencephalopathy Syndrome.

Iran J Kidney Dis 2017 Nov;11(6):408

Department of Nephrology, Firoozgar Clinical Research Development Center, Iran University of Medical Sciences, Tehran, Iran.

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November 2017

Acute Interstitial Nephritis Induced by Citrullus Colocynthis.

Iran J Kidney Dis 2017 Oct;11(5):385-387

Department of Medicine, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran.

Acute interstitial nephritis (AIN) is known as a common cause of acute kidney injury, found in 15% to 27% of kidney biopsies. Drug-induced AIN is currently the most common cause of AIN. The most common medications causing AIN are antibiotics and nonsteroidal anti-inflammatory drugs. We describe a case of Citrullus colocynthis (herbal remedy for diabetes mellitus and weight reduction) that induced AIN. A 31-year-old woman with major thalassemia, diabetes mellitus, and hepatitis C infection was admitted because of flank pain and unexpected increase in serum creatinine level. She had been using Citrullus colocynthis for 3 months. Kidney biopsy results suggested AIN. She did not respond to steroid therapy and underwent hemodialysis. We suggest the use of Citrullus colocynthis as a herbal medicine with extreme caution.
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October 2017

Occult Hepatitis C Infection Among Hemodialysis Patients: A Prevalence Study.

Ann Hepatol 2017 Jul-Aug;16(4):510-513

Department of Gastroenterology and Liver Diseases, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Introduction And Aim: Occult hepatitis C infection (OHCI) is the presence of HCV-RNA in the liver or peripheral blood mononuclear cells (PBMC) accompanying with negative serologic results. The aim of this study was to evaluate the prevalence of OHCI among Iranian chronic hemodialysis (HD) patients.

Material And Methods: In this cross sectional study 200 chronic HD patients with negative HCV antibody enrolled the study. Blood sample of patients were obtained, followed by Polymerase Chain reaction (PCR) testing for detection of HCV RNA. Patients with positive serum HCV RNA were considered as manifest hepatitis C infection (MHCI). However, patients with negative serum HCV RNA underwent further tests on PBMCs for detection of OHCI.

Results: Serum HCV RNA was positive in 2 (1%) patients whom considered as MHCI, and 6 (3.03%) patients had positive PBMC HCV RNA.

Conclusion: In conclusion, chronic HD patients have been considered as a high risk group for hepatitis C infection. The results of this study suggest that these patients are also at risk for OHCI. Furthermore, evaluating PBMCs to detect HCV RNA would be a sensitive diagnostic method to find OHCI patients.
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http://dx.doi.org/10.5604/01.3001.0010.0277DOI Listing
April 2018

Predictors of Clinical Outcomes in Hemodialysis Patients: a Multicenter Observational Study.

Iran J Kidney Dis 2017 May;11(3):229-236

Nephrology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Introduction: Cardiovascular and noncardiovascular mortality and morbidity rates of hemodialysis patients are high despite improvement in dialysis delivery.

Materials And Methods: Hemodialysis patients (n = 532) from 9 hemodialysis facilities were enrolled in this cohort study in September 2012. Causes of death, hospitalization, and hemodialysis exit were recorded during a 28-month follow-up period. A Cox proportional hazard model was used to predict death adjusting for case-mix variables, nutrition variables, bone mineral variables, Kt/V, vascular access, and Charlson comorbidities index.

Results: Patients were 56.0 ± 15.4 years old (57% men). A total of 161 patients (30%) died (17 per 100 patient years), and the most common causes of death were cardiovascular diseases (42%) and infections (25%). Transplantation rate was 7 per 100 patient years and hospitalization frequency was 0.76 per patient year. Based on the multivariable Cox proportional hazard model, the mortality hazard ratio was 1.03 (95% confidence interval [CI], 1.01 to 1.05; P = .007) for age (years), 0.21 (95% CI, 0.11 to 0.40; P < .001) for serum albumin (g/dL), 1.21 (95% CI, 1.03 to 1.42; P = .02) for serum phosphorus (mg/dL), 1.001 (95% CI, 1.0005 to 1.002; P = .001) for serum intact parathyroid hormone (pg/mL), 1.58 (95% CI, 1.01 to 2.51; P = .047) for hemodialysis catheter (compared to arteriovenous fistula), and 1.75 (95% CI, 1.59 to 1.94; P < .001) for the Charlson score.

Conclusions: Nutritional factors, comorbidities, vascular access, and abnormal mineral metabolism are the main determinants of mortality and morbidity in hemodialysis patients.
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May 2017

Lithium Nephrotoxicity: When Is the Time for Nephrology Consultation?

Iran J Public Health 2016 Jul;45(7):958-9

Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4980356PMC
July 2016

Bile cast nephropathy due to cholestatic jaundice after using stanozolol in 2 amateur bodybuilders.

Iran J Kidney Dis 2015 Jul;9(4):331-4

Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran.

Elevated level of bile can cause bile cast nephropathy, which can be seen in patients with severe cholestatic liver disease. Stanozolol is a C17α-alkylation steroid derived from dihydrotestosterone and its major adverse effect is cholestatic jaundice. We report 2 bodybuilders who received stanozolol for 6 weeks and developed icterus. Serum total bilirubin was around 50 mg/dL. Liver biopsy showed intrahepatic cholestasis. In spite of fluid and albumin therapy, serum creatinine increased and the patients experienced oliguria. Urine sediment showed granular cast and normal erythrocyte count. Protein excretion in 24-hour urine was less than 1000 mg in both patients. Hemodialysis was started on and renal biopsy revealed acute tubular epithelial cell damage along with bile pigment (cast) deposition, compatible with bile cast-related nephropathy. Serum bilirubin decreased gradually and urine output increased. Serum creatinine was around 1.5 mg/dL in both of the patients 2 months after discharge.
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July 2015

Remote ischemic preconditioning for prevention of contrast-induced acute kidney injury in diabetic patients.

Iran J Kidney Dis 2014 Nov;8(6):457-60

Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran.

Introduction: There are some clinical trials showing that short-term ischemia in one organ can protect different organs against higher intensity and longer ischemic insult. We designed a study to assess whether remote ischemic preconditioning (RIPC) on one organ can decrease the rate of contrast-induced acute kidney injury (AKI) in diabetic patients who undergo coronary artery angiography (CAA).

Materials And Methods: This randomized control trial included 96 diabetic patients who were candidates for CAA. Exclusion criteria were congestive heart failure and complications during CAA. All of the patients received 1000 mL of normal saline before CAA. The RIPC group underwent 3 cycles of 5-minute ischemia in their right arm. Serum creatinine was measured before and 24 hours after CAA.

Results: Contrast-induced AKI was reported in 5 cases in the control group and 1 case in the RIPC group (P = .13, odds ratio, 5.4). The differences in serum creatinine level before and after the procedure was significantly lower in RIPC group than that in the control group (P = .04, odds ratio, 0.08). Serum creatinine rise significantly correlated with contrast dose (P = .02) and a history of hypertension (P = .02) in both groups.

Conclusions: Ischemic preconditioning had a protective effect on contrast-induced AKI in our study. Since this method is harmless and cost effective, further studies on patients with chronic kidney disease is required to evaluate addition of ischemic preconditioning to our clinical practice for prevention of contrast-induced AKI.
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November 2014

Interferon-gamma release assay agreement with tuberculin skin test in pretransplant screening for latent tuberculosis in a high-prevalence country.

Iran J Kidney Dis 2014 Jul;8(4):329-32

Department of Medicine, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran.

Introduction: Tuberculosis reactivation is one of significant complications after transplantation. Tuberculin skin test (TST) has been the major available screening test in end-stage renal disease patients, but it is associated with a low accuracy. Recently, an interferon-gamma release assay (IGRA) has been approved as a substitution test in diagnosis of Mycobacterium tuberculosis infection. This study aimed to compare the ability of the TST and IGRA in the diagnosis of latent tuberculosis in hemodialysis patients and investigate risk factors of having positive test results.

Materials And Methods: Forty-seven hemodialysis patients underwent the IGRA and TST tests. Demographic data and blood samples were collected and chest radiography was done for all participants.

Result: Abnormal chest radiography was reported in 24% of the study group. The IGRA and TST were positive in 11 (23.4%) and 20 patients (43.5%), respectively. The agreement coefficient (kappa) between the IGRA and TST was 0.31. Positive TSTs were significantly associated with male sex and abnormal chest radiography. Diabetes mellitus was a risk factor for a positive IGRA result (P = .01).

Conclusions: The IGRA test is not a sensitive test for detection of latent tuberculosisin hemodialysis patients residing in high-prevalence areas. We suggest that assessment of cellular immunity response in end-stage renal disease patient be a priority before reliance on the IGRA test result.
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July 2014

A paradigm shift towards quality of kidney transplantation in Iran.

Authors:
Shokoufeh Savaj

Iran J Kidney Dis 2014 May;8(3):161-2

Firoozgar Hospital, Tehran University of Medical Sciences, Tehran, Iran.

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May 2014

Omega-3 and serum homocysteine level in hemodialysis patients.

Authors:
Shokoufeh Savaj

Iran J Kidney Dis 2013 Nov;7(6):421-2

Firoozgar Hospital, Tehran University of Medical Sciences, Tehran, Iran.

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November 2013

Hepatitis B virus complications of pregnancy after kidney transplantation.

Authors:
Shokoufeh Savaj

Iran J Kidney Dis 2013 Sep;7(5):338-9

Firoozgar Hospital, Tehran University of Medical Sciences, Tehran, Iran.

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September 2013

How does patient management knowledge integrate into an illness script?

Educ Health (Abingdon) 2012 Sep-Dec;25(3):153-9

Philosophy of Science Department, Institute for Humanities and Cultural Studies, Tehran, Iran.

Context: Studies in medical expertise have shown that the medical knowledge of physicians is organized in a way that is easily retrievable when they encounter patients. These knowledge structures, called illness scripts, contain various pieces of information, including signs, symptoms, and enabling conditions, concerning a given disease. Illness script research has principally focused on understanding how physicians make diagnoses, while patient management has received much less attention. Although the work on diagnostics has taught us many things about the nature of medical expertise, focusing solely on this aspect provides only a narrow perspective on the subject, resulting in an incomplete depiction of medical experts. The goal of the present study was to experimentally determine how management knowledge plays a role in the development of illness scripts and developing expertise.

Materials And Methods: Medical students, interns, and residents were instructed to think aloud while reading a case with either a diagnostic or management focus. The recall protocols were examined in terms of illness script components, as well as diagnostic and management accuracy.

Findings: Both residents and interns were sensitive to the focus and generated significantly more management-items when thinking about management than when they were asked to diagnose a clinical case. They also provided more management items than medical students in management-focus. The performance of interns was superficially similar to that of residents in terms of management proportion, but with respect to both diagnostic and management accuracy they resembled medical students. Medical students, in contrast, were very persistent and insensitive to the focus.

Conclusions: Medical expertise could be characterized by the emergence of illness scripts that are rich in terms of management knowledge. Illness scripts can generally be applied to any medical encounter that includes diagnosis and management, and expertise research should be extended to cover both domains.
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http://dx.doi.org/10.4103/1357-6283.109791DOI Listing
April 2014

Grape seed for prevention of reperfusion injury.

Authors:
Shokoufeh Savaj

Iran J Kidney Dis 2013 Jan;7(1):1-2

Firoozgar Hospital, Tehran University of Medical Sciences, Tehran, Iran.

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January 2013

An overview of recent advances in pathogenesis and diagnosis of preeclampsia.

Iran J Kidney Dis 2012 Sep;6(5):334-8

Firoozgar Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Preeclampsia is a serious complication of pregnancy, which is the cause of 60 000 maternal deaths annually worldwide. In addition to the well-known maternal risk factors such as hypertension, diabetes mellitus, antiphospholipid antibody syndrome, obesity, aging, and multiple pregnancies, recent studies have identified the role of genetic and immunological factors in the pathogenesis of preeclampsia. In particular, imbalance between angiogenic and anti-angiogenic factors, anti-angiotensin II type 1 receptor antibodies and dysregulation of oxygen supplies can cause preeclampsia. A group of biomarkers have been introduced for diagnosis of preeclampsia. Chief among them is the ratio of soluble fms-like tyrosine kinase-1 to placental growth factor, which can be used in clinical practice. Recent studies have shown high specificity and sensitivity of these markers for early diagnosis of preeclampsia, which is critical for prevention of fetal and maternal complications.
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September 2012

Vitamin D, parathyroid hormone, and bone mineral density status in kidney transplant recipients.

Iran J Kidney Dis 2012 Jul;6(4):295-9

Firoozgar Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Introduction: Bone disease and bone fractures are common among kidney transplant recipients. The aim of this study was to investigate the prevalence of vitamin D deficiency, hyperparathyroidism, and osteoporosis kidney transplant patients.

Materials And Methods: A total of 113 kidney transplant recipients (58 women and 55 men) were selected consecutively from the transplant clinic between January and April 2010. A serum sample from each patient was analyzed for creatinine, calcium, phosphorus, 25-hydroxyvitamin D, and intact parathyroid hormone levels. Bone mineral density was measured by the dual energy x-ray absorptiometry method and classified according to the classification of the World Health Organization. Risk factors of bone mineral density outcomes were evaluated in univariable and multivariable analyses.

Results: Forty-five percent of the patients had vitamin D deficiency and 76.2% had hyperparathyroidism. There was a significant correlation between vitamin D deficiency and high serum parathyroid hormone (P = .04) and serum creatinine levels (P = .001). However, there were no significant associations of serum calcium and phosphorus with vitamin D or parathyroid hormone levels. The osteoporosis and osteopenia were reported in 12.4% and 52.2% of the recipients in the lumbar spine and 45.1% and 36.3% of the patients in the femoral neck, respectively. Multivariable analyses showed that there were significant correlations between patients' age and body mass index and femoral neck osteoporosis. Risk factors for lumbar spine osteoporosis were end-stage renal disease duration, serum calcium, and body mass index.

Conclusions: Vitamin D deficiency, hyperparathyroidism, and osteoporosis are very common in our kidney transplant recipients. Early diagnosis and treatment of these abnormalities should be included in the posttransplant follow-up of patients in order to prevent severe bone diseases and bone fractures.
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July 2012

Massive proteinuria and autosomal dominant polycystic kidney disease: a rare coincidence.

Iran J Kidney Dis 2012 Jan;6(1):73-6

Department of Nephrology, Firoozgar General Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Autosomal dominant polycystic kidney disease (ADPKD) with nephrotic syndrome is a rare coincidence. Among 19 reported cases since 1972, focal glomerulosclerosis is the dominant reported pathology. Here, we report the 6th case of focal segmental glomerulosclerosis with ADPKD. A 29-year-old man with a history of APCDK presented with massive proteinuria. He had a history of concurrent leptospirosis and brucellosis, and trace proteinuria and mild hypertension had been diagnosed 4 years earlier. Urine study showed proteinuria (21 g/d) and hematuria. Kidney biopsy report was compatible with focal and segmental sclerosis. The patient received prednisolone and cyclosporine. After 4 months, proteinuria decreased to 600 mg/d. Patients with ADPKD who show massive proteinuria should undergo kidney biopsy. It is possible that different mutations in these patients could clarify the nature of this coincidence.
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January 2012

Tubulointerstitial nephritis and uveitis: report of a rare syndrome.

Iran J Kidney Dis 2011 Jan;5(1):66-8

Tehran University of Medical Sciences, Iran.

Tubulointerstitial nephritis and uveitis (TINU) is a rare syndrome with unknown pathogenesis. Data have shown a higher prevalence in female gender. We present a man with tubulointerstitial nephritis and uveitis syndrome and antitubular antibody. A 23-year-old man presented with a history of weight loss, nausea, and vomiting, and uveitis. His serum creatinine was 2.1mg/d with pyuria and proteinuria in urinalysis. Other laboratory and imaging studies were unremarkable. Kidney biopsy showed granulomatous interstitial nephritis. Normal renal tissue specimen treated with patient's serum showed focal cytoplasmic staining in cortical tubular cells. The patient received prednisolone for 1 month. Interstitial nephritis and uveitis were well controlled. There was no recurrence in 1-year follow-up. We suggest that tubulointerstitial nephritis and uveitis syndrome should be considered in differential diagnosis of patients with interstitial nephritis and uveitis. Antitubular antibody may be used as a diagnosis marker for this syndrome.
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January 2011

Estimation of glomerular filtration rate with creatinine-based versus cystatin C-based equations in kidney transplant recipients.

Iran J Kidney Dis 2009 Oct;3(4):234-8

Department of Nephrology and Transplant, Hasheminejad Kidney Hospital, Iran University of Medical Sciences, Tehran, Iran.

Introduction: Serum cystatin C is more sensitive for glomerular filtration rate (GFR) measurement, but it is not available for clinical use in all laboratories. Regarding the importance of accurate estimation of GFR in kidney transplant recipients, we compared cystatin C-based equations with creatinine-based formulas to estimate GFR as precisely and simply as possible in kidney transplant recipients.

Materials And Methods: Seventy living donor kidney transplant recipients with stable kidney function were enrolled in our study. The patients' GFRs were estimated by 3 creatinine-based equations (the modification of diet in renal disease [MDRD], abbreviated MDRD, and Cockcroft-Gault) and 5 cystatin C-based equations (Filler, Le Bricon, Rule, Hoek, and Larsson), and the results were analyzed.

Results: The mean age of the recipients was 38.7 +/- 13.4 years. The mean GFRs were 67.1 +/- 25.9 mL/min/1.73 m2, by the Cockcroft-Gault; 61.0 +/- 17.7 mL/min/1.73 m2, by the abbreviated MDRD; and 60.0 +/-18.6 mL/min/1.73 m2, by the MDRD formulas. Cystatin C-based GFR estimations were 43.6 +/- 16.2 mL/min/1.73 m2, 44.0 +/- 13.2 mL/min/1.73 m2, 33.8 +/- 14.1 mL/min/1.73 m2, 35.6 +/- 13.7 mL/min/1.73 m2, and 36.9 +/- 13.6 mL/min/1.73 m2 by the Filler, Le Bricon, Larsson, Rule, and Hoek equations, respectively. The estimates by creatinine-based and cystatin C-based equations were significantly different and the MDRD estimate was the closest to the cystatin C-based GFRs.

Conclusions: Our findings revealed the MDRD equation could be provide a closer estimate of GFR to the cystatin C-based equations than other creatinine-based GFR calculations in kidney transplant recipients.
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October 2009

Posttransplant diabetes mellitus in kidney allograft recipients at Shaheed Hasheminejad Hospital.

Iran J Kidney Dis 2008 Jan;2(1):46-9

Department of Kidney Transplantation, Shaheed Hasheminejad Hospital, Iran University of Medical Sciences, Tehran, Iran.

Introduction: Our aim was to evaluate the frequency and risk factors of posttransplant diabetes mellitus (PTDM) at our kidney transplant center, and to compare graft and patient outcomes between the kidney recipients with and without PTDM.

Materials And Methods: We studied 203 kidney transplant recipients with a negative history of diabetes mellitus before transplantation. We examined them for PTDM and made diagnosis on the basis of the American Diabetes Association criteria. Measurements of plasma glucose were carried out from 3 months to 24 months after transplantation. All data including recipient and donor demographics, cause of end-stage renal disease, cytomegalovirus and hepatitis C virus antibody tests, and patient and graft outcomes were assessed in relation to PTDM.

Results: High fasting plasma glucose was seen in 24 (11.8%), 19 (9.4%), 16 (7.9%), and 13 (6.4%) patients at 3, 6, 12, and 24 posttransplant months, respectively. Moreover, impaired glucose tolerance was seen in 17 (8.4%), 16 (7.9%), 17 (8.4%), and 19 (9.4%) patients at the corresponding times, respectively. Accordingly, 39 patients (19.2%) were diagnosed to have PTDM. The mean age of the kidney recipients with PTDM was 46.5 +/- 12.3 years as compared to 38.6 +/- 13.4 years in nondiabetic kidney recipients (P = .02). The 5-year patient and graft survival rates were not significantly different between the kidney recipients with and without PTDM.

Conclusions: This study showed that PTDM is a common metabolic disorder in our kidney transplant patients. We recommend a less diabetogenic immunosuppressive protocol, especially for our older recipients.
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January 2008

Improvement in uremic symptoms after increasing daily dialysate volume in patients on chronic peritoneal dialysis with declining renal function.

Int Urol Nephrol 2004 ;36(3):437-43

Peritoneal Dialysis Program, University Health Network and University of Toronto, Canada.

Objective: Patients on peritoneal dialysis (PD) can develop uremic symptoms as their residual renal function declines. In this retrospective study, we assessed the effect of increasing the dose of dialysis in patients who developed uremic symptoms.

Methods: Patients on PD who had an increase in their dialysis dose due to either the appearance of uremic symptoms or to worsening biochemical parameters were included in this study. These patients had to have been on PD for at least 6 months before and after the increase in their dialysis dose. Patients whose dialysis dose was increased after the initial Adequest (done within 2-3 months of starting PD) findings or for reasons other than underdialysis were excluded from this study. The symptoms studied in 104 patients included fatigue, anorexia, insomnia, pruritus and nausea. The presence or absence of theses symptoms was evaluated before and after the increase in the dialysis volume. Several clinical and laboratory data including the adequacy results were compared before and after the increase in dialysis dose.

Results: Patients were on PD for 24.6+/-16 months when dialysis dose was increased. Eighty-five (82%) of them were on continuous ambulatory peritoneal dialysis (CAPD) while the remaining were on continuous cycler peritoneal dialysis (CCPD). Fatigue was the most common symptom that led to an increase in the dialysis dose (64%). The prevalence of all the symptoms studied decreased significantly after the increase in dose of dialysis. The weekly peritoneal creatinine clearance increased from 47.35+/-0.88 to 57.34+/-1.401 (P < 0.0001) and the weekly Kt/V increased from 1.8+/-0.03 to 2.27+/-0.05 (P < 0.0001). The daily urine volume and the residual GFR decreased from 318.7+/-36.4 to 151.9+/-22.8 ml/day (P < 0.0001) and 2.05+/-0.2 to 0.82+/-0.12 ml/min (P < 0.0001) respectively during the study period.

Conclusion: The prevalence of all uremic symptoms decreased significantly after the daily dialysate volume was increased. The improvement in symptoms despite the decline in residual function emphasizes the beneficial effect of increased dialysate volume, which produced a significantly higher peritoneal creatinine clearance and Kt/V after the change in the PD prescription.
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http://dx.doi.org/10.1007/s11255-004-8788-9DOI Listing
October 2005