[Frequency of dyslipidemia and its accompanying factors in hemodialysis patients]

Dyslipidemia is a common disorder and one of the major causes of the atherosclerosis development and progression in hemodialysis patients. Timely diagnosis and treatment of dyslipidemia can reduce mortality and morbidity of cardiovascular disease and protect the remaining function of kidneys in patients with chronic renal failure. This study was performed with the objective of evaluating the frequency of dyslipidemia and its accompanying factors in hemodialysis patients. In a descriptive cross-sectional study, 182 patients with chronic renal failure referred to hemodialysis units of Baqiyatallah and Shahid Chamran hospitals, Tehran in 2012 were studied. For data collection, in addition to demographic questionnaire, serum levels of cholesterol, triglyceride, HDL and LDL were measured. Data analysis was done using Chi-square, independent t-test, and one-way ANOVA. The significance level was considered to be p<0.05. In this research, 8.2% of the patients had hypercholesterolemia, 26.4% hypertriglyceridemia, and 6.8% LDL level more than 130. In half of the patients, serum HDL was less than 35. A significant relationship was observed between dyslipidemia and variables of gender [p=0.001], duration of hemodialysis [p=0.004], education level [p=0.005], and weight [p=0.007]. Dyslipidemia has a high prevalence in hemodialysis patients, especially patients with low literacy and obesity. So that, at least one of the components of lipid profiles is abnormal in more than 80% of hemodialysis patients. Therefore, planning to improve life style and provide training on proper nutrition and physical activity is recommended as one of the principles of care in hemodialysis patients

[ effect of vitamin C supplementation on serum levels of hemoglobin, hematocrit and ferritin in hemodialysis patients: a randomized clinical trial]

Anemia is one of the common complications of chronic renal failure and vitamin C can improve anemia through releasing iron from ferritin and its transfer from the reticuloendothelial system to transferrin. This study was performed with the objective of evaluating the effect of vitamin C supplementation on serum levels of hemoglobin, hematocrit, and ferritin in hemodialysis patients. In a double-blind clinical trial, 178 patients with chronic renal failure were randomly divided into three groups of intervention, control, and witness. In the intervention group, 250 mg vitamin C, 250 mg of vitamin C was injected intravenously at the end of each hemodialysis session three times a week for 8 weeks. In the witness group, same amount of placebo saline was injected at the same time, and no intervention was performed in the control group. Laboratory parameters, including serum levels of hemoglobin, hematocrit, and ferritin were measured at the beginning and end of the intervention. Data analysis was performed by Chi-square and one-way ANOVA. The significance level was considered to be p < 0.05. There were significant differences in serum levels of hemoglobin and hematocrit in the intervention group, but, the changes of the serum level of ferritin were not significant in any of the groups. The results of this study showed that vitamin C supplementation in hemodialysis patients can significantly increase the mean serum levels of hemoglobin and hematocrit, however, it cannot significantly change the serum ferritin level

Impact of cigarette smoking on kidney transplant recipients. a systematic review

Cigarette smoking has adverse effects on kidney transplant recipients, causing cardiovascular disease, kidney function impairment, and cancer. However, there are surprisingly few studies on the impact of cigarette smoking among kidney transplant recipients and its consequences after transplantation. We performed a systematic review of the literature to identify the effects of cigarette smoking on patient and graft survival rates among kidney transplant recipients. We searched the PubMed from 1968 to 2009 to identify studies on the effect of cigarette smoking on kidney transplant recipients, using the following keywords: kidney transplantation, cigarette, smoking, tobacco, and nicotine. The electronic and manual searches yielded 357 articles, of which 39 were considered potentially relevant by titles and abstracts and were selected for full text review. Twenty-seven irrelevant reports were excluded. A total of 12 papers were selected for review, comprising of 1801 kidney transplant recipients with a history of smoking. The impact of cigarette smoking on kidney recipient survival was only evaluated by 6 studies and the relative risk of smoking for death was available in 3 reports, varying between 0.8 and 2.2. Cigarette smoking was an independent risk factor for patient death. In addition, on univariable and multivariable analyses, graft survival correlated with a history of cigarette smoking and the relative risk for graft failure ranged from 1.06 to 2.3. Cigarette smoking was associated with an increased risk of death and graft loss. Therefore, every attempt should be made to encourage kidney transplant candidates to stop smoking

Marital adjustment in patients on long-term hemodialysis. A case-control study

This study was conducted to compare marital adjustment between patients on long-term hemodialysis and healthy controls and to determine whether the psychological symptoms correlate with marital adjustment in these patients. In a case-control study, 40 patients on long-term hemodialysis and 40 healthy participants were compared for the quality of marital relationship. The Revised Dyadic Adjustment Scale was used for interviews of marital relationship, which includes total marital adjustment and its subscales of marital consensus, affection expression, marital satisfaction, and marital cohesion. Symptoms of anxiety and depression and the Ifudu comorbidity scale were also assessed in the patients group. Marital consensus, affection expression, marital satisfaction, marital cohesion, and the overall marital relationship were significantly poorer in the patients on hemodialysis than in the controls. Also, symptoms of anxiety were more severe among the patients on hemodialysis in comparison with that in the controls. However, this was not the case for symptoms of depression. In the patients on hemodialysis, the severity of anxiety slightly correlated reversely with the total marital relationship score and marital satisfaction subscale. Depression correlated reversely with total marital adjustment, affection expression, marital satisfaction, and marital cohesion. Finally, some marital relationship subscales showed poorer results in men on dialysis, younger patients, and those with higher educational levels. Marital adjustment in patients on hemodialysis, which is linked with depressive symptoms and anxiety, is poorer compared to the healthy controls. This finding shows the necessity of an appropriate family approach for patients on long-term dialysis

Posttransplant lymphoproliferative disorders in kidney transplant recipients. An Iranian multicenter experience

Limited data with adequate sample size exist on the development of posttransplant lymphoproliferative disorder [PTLD] in living donor kidney recipients. We conducted a retrospective cohort study on the data of 10 transplant centers to identify the incidence of PTLD in Iran. Data of 9917 kidney transplant recipients who received their kidneys between 1984 and 2008 were reviewed. Fifty-one recipients [0.5%] who developed PTLD were evaluated with a median follow-up of 47.5 months [range, 1 to 211] months. Patients with PTLD represented 24% of all posttransplant malignancies [51 out of 211 cases]. There was no relationship between PTLD and sex [P = .20]. There were no statistically significance differences considering the age at transplantation between patients with and without PTLD. The late-onset PTLD [70.6%] occurred more frequently compared to the early form. There was no signification relationship between early-onset and late-onset groups in terms of clinical course and outcome. In patients who received azathioprine, PTLD was more frequent when compared to those who received mycophenolate mofetil [P < .001]. The lymph nodes were the predominantly involved site [35.3%], followed by the gastrointestinal tract, brain, kidney allograft, lung, ovary, vertebrae, and palatine. Age at diagnosis and the time from transplantation to diagnosis were comparable for various involvement sites of PTLDs. The overall mortality in this series of patients was 51.0%. Posttransplant lymphoproliferative disorder is a rare but devastating complication and long-term prognosis can be improved with early recognition and appropriate therapy

Successful treatment of infective endocarditis in four kidney transplant recipients

Infective endocarditis [IE] is a serious complication in kidney transplantation, leading to graft loss and a high mortality rate. We report 4 successfully managed cases of IE in kidney transplant recipients. Blood culture revealed Enterococcus in 2 patients, group D Streptococcus in 1, and no bacteria in 1. All of the patients were diagnosed based on at least 2 major Duke criteria for diagnosis of IE. Although a mild increase in the serum creatinine level was observed in 3 out of 4 patients, no graft rejection occurred during the follow-up. Early diagnostic and therapeutic intervention, particularly intensive antibiotic therapy and surgical management can preserve the patient and the kidney allograft. Studies on previous recurrent infections and simultaneous diseases such as cytomegalovirus in these patients are warranted