Uremic pruritus and serum phosphorus level

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

Impact of UGT1A9 polymorphism on mycophenolic acid pharmacokinetic parameters in stable renal transplant patients

There are wide individual differences in pharmacokinetic parameters of mycophenolate mofetil [MMF] among transplanted patients. Some studies have shown that single nucleotide polymorphisms [SNPs] of the Uridine Diphosphate Glucuronosyl Transferase1A9 [UGT1A9] are responsible for these differences in early days after transplantation. Therefore it was decided to evaluate the influence of UGT polymorphism on MMF pharmacokinetics among stable Iranian transplant patients. This was a cross sectional study from March 2008 through December 2008 in Imam Khomeini Hospital affiliated to the Tehran University of Medical Sciences in Iran. Blood samples were taken from 40 de novo stable Iranian renal transplant patients taking 2 g MMF daily with Sr[Cr]

Pharmacokinetic study of mycophenolic acid in Iranian kidney transplant patients

The purpose of this study was to characterize the pharmacokinetic parameters of mycophenolic acid [MPA] in Iranian kidney transplant patients. Plasma MPA concentration of mycophenolate mofetile [MMF] 1 gram two times a day was measured in 21 Iranian kidney transplant recipients receiving treatment. Patients who entered the study had been transplanted for more than 3 months and their drug level was supposed to be at steady state. MMF concentration was measured with High- Performance Liquid Chromatography [HPLC]. The plasma MPA concentration-time curve was characterized by an early sharp peak at about 1 hour postdose. The mean Area Under Curve [AUC], Cmax and Tmax were 47.0 +/- 18.3 microg.h/ml, 18.6 +/- 8.5 microg/ml and 1.0 +/- 0.5 hours respectively. The plasma MPA concentration-time curve pattern of Iranian patients was similar and consistent with previously reported profiles in other populations taking the same dose.

The role of clinical pharmacy services in achieving treatment targets in Iranian haemodialysis patients

<p><b>INTRODUCTION</b>The number of patients suffering from chronic kidney disease (CKD) is increasing worldwide. Hyperphosphataemia and high serum calcium (Ca) and phosphorus (P) product contribute to the substantial increase in cardiovascular events in CKD patients. Although reports of CKD complications in Iranian haemodialysis (HD) patients are comparable to data from other developed countries, management of these complications has failed to meet generally accepted targets. This study evaluated the impact of clinical pharmacy services in the management of complications in HD patients.</p><p><b>METHODS</b>During a six-month prospective study, clinical pharmacists conducted medical visits in the HD ward and adjusted the patients' medications according to their laboratory findings.</p><p><b>RESULTS</b>Serum Ca concentration was increased in hypocalcaemia patients and decreased in hypercalcaemia patients until it reached the optimal range in both groups. A decline in serum P level was noted in hyperphosphataemia patients, although it did not reach the target range. The Ca × P product decreased in patients with Ca × P > 55 mg2/dL2. Although it did not reach the goal, there was an increase and decrease in serum intact parathyroid hormone (iPTH) concentration in suboptimal and supraoptimal range patients, respectively. Serum Ca, P and iPTH levels did not change in patients with optimal values at the initiation of the study. Haemoglobin concentration increased in anaemic patients and serum ferritin reached target values in all patients. Total cholesterol, low-density lipoprotein cholesterol and triglycerides decreased to near-optimal values in dyslipidaemia patients.</p><p><b>CONCLUSION</b>This study showed that clinical pharmacy services at the HD centre can improve the management of complications in CKD patients.</p>

Sexual and reproductive function in end-stage renal disease and effect of kidney transplantation / 亚洲男科学杂志(英文版)

Advanced chronic kidney disease is associated with impaired spermatogenesis and testicular damage. Semen analysis typically shows a decreased volume of ejaculate, oligo- or complete azoospermia, and a low percentage of motile sperm. Erectile dysfunction (ED) is also common in patients with chronic renal failure (CRF) and is observed in excess of 50% of these patients. There have been ongoing improvements in survival and quality of life after renal transplantation. One of the most impressive aspects of successful renal transplantation in the young people is the ability of the male patient to father a child. In this article we first review pathophysiology of reproductive failure in end-stage renal disease (ESRD), then ED in ESRD and its management are discussed, finally sexual function in renal transplant patients and management of ED in these patients are reviewed.

Burden of chronic kidney disease in Iran. A screening program is of essential need

The latent nature of chronic kidney disease [CKD] in primary stages precludes early diagnosis. This necessitates plans such as screening, but we should first introduce CKD as a public health problem. This study was designed to define the burden of CKD in Iran. We calculated disability-adjusted life years [DALYs] according to the World Health Organization's practical guidelines for national burden of disease studies. The sum of years of life lost and years lived with disability were estimated for CKD stages 1 to 4 and end-stage renal disease [ESRD] based on the national registry data and the published reports about CKD in Iran in 2004. Over 700 000 people were estimated to have CKD in Iran in 2004 and 61 000 new cases of CKD were anticipated. The prevalence rate of CKD was estimated to be 1083 and its incidence rate was 173.5 per 100 000 population. Chronic kidney disease was responsible for 1 145 654 DALYs. The highest DALYs for stages 1 to 4 of CKD were due to unknown etiology, diabetes mellitus, and hypertension [382 000 years, 347 400 years, and 311 800 years, respectively]. The DALY for ESRD and CKD stages 1 to 4 were 21 490 years and 1 124 164 years, respectively. The present study provides an estimate of the burden of CKD in Iran. As CKD can be controlled by practical cost-effective plans, we strongly recommend the information given by this study be considered for future action plans

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

Reproduction in women with end-stage renal disease and effect of kidney transplantation

Menstrual problem is common among women with chronic kidney disease, and patients with end-stage renal disease usually have amenorrhea. The rate of pregnancy in women on dialysis is low. Fetal survival in this population has improved, with half of such pregnancies resulting in delivery of a live infant. However, prematurity remains common and accounts for the low-birth weight of these infants. Intensifying hemodialysis by increasing the frequency of treatments is associated with longer gestation and increased likelihood of a successful pregnancy. Intense hemodialysis also improves the control of maternal intravascular volume and reduces the risk of hypotension due to excessive ultrafiltration. Women with chronic kidney disease tend to experience decreased libido and reduced ability to reach orgasm. Sexual difficulties in uremic patients are often worsened by hemodialysis, with a lowered frequency of intercourse, reduced sexual desire, and an increased incidence of sexual failure. There have been ongoing improvements in survival and quality of life after kidney transplantation. In most patients, sexual desire increases significantly after successful transplantation; however, improvement in the frequency of sexual activity and the overall sexual satisfaction is not as high as that in sexual desire. These have been accompanied by an improvement in reproductive function. Pregnancy success rate exceeds 90% after the first trimester in women with kidney transplant. Contraceptive counseling should be provided before transplantation, because ovulatory cycles may begin within 1 to 2 months after transplantation in women with functioning grafts. Breastfeeding is discouraged for patients taking any immunosuppressive drugs

Relation of antioxidants and acute-phase reactants in patients receiving hemodialysis

To investigate the oxidative stress and its association with antioxidants in patients on hemodialysis, we evaluated the levels of albumin, C-reactive protein [CRP], ferritin, vitamin E, glutathione, and total antioxidant capacity in these patients. In a cross-sectional study, we enrolled 25 patients on maintenance hemodialysis and measured the inflammatory and oxidative stress indicators consisting of the plasma concentrations of glutathione, vitamin E, and total antioxidant capacity. The acute-phase inflammatory response was assessed by determining the serum levels of CRP and albumin as well as the plasma level of ferritin. Antioxidants and acute-phase reactants in men and women and their association with age and their correlations with each other were analyzed. The mean age of the patients was 53.6 +/- 14.1 years [range, 29 to 70 years]. They had been on hemodialysis for a mean duration of 4.66 +/- 5.08 years. There were no association of sex or age with the levels of antioxidants and acute-phase reactants. Plasma level of glutathione significantly correlated with CRP [r = 0.48; P = .01] and serum albumin [r = 0.42; P = .04]. Duration of dialysis did not correlate with the antioxidants or acute-phase reactants. Although it is reasonable to see an association between acute-phase reactants and levels of antioxidants in patients on hemodialysis, we failed to show such a relation. It is recommended that other biomarkers of oxidative stress and their relation in patients with kidney failure be investigated

Posttransplant malignancies and their relationship with human leukocyte antigens in kidney allograft recipients

Kidney transplant recipients are at increased risk of cancers, most frequently skin cancers, and in some regions, Kaposi sarcoma and non-Hodgkin lymphoma. We sought to investigate the associate of the most frequent malignancies among our patients with human leukocyte antigens [HLAs]. We performed a retrospective study on 44 kidney allograft recipients who had posttransplant malignancy and 44 kidney allograft recipients without malignant lesions [control group]. All of the patients had been treated by immunosuppressive regimens including cyclosporine plus prednisolone or cyclosporine, prednisolone, and mycophenolate mofetil. Data on HLA typing were achieved from their transplant records. There were 15 patients [34.1%] with Kaposi sarcoma; 13 [29.6%] with non-Hodgkin lymphoma, 6 [13.6%] with skin cancer, 2 [4.5%] with ovary cyst adenocarcinoma, and 8 [18.2%] with other tumors. The mean interval from transplantation to diagnosis of malignancy was 15.3 month. Twelve patients died of cancer during the follow-up [mean, 12.3 years]. No significant difference was noted in the age, sex, and time of transplantation between these patients and those in the control group. Kaposi sarcoma was associated with HLA-CW4 [P = .03] with an odds ratio of 4.96 [95% confidence interval, 2.90 to 8.12]. We found HLA-CW4 as a risk factor of Kaposi sarcoma in kidney allograft recipients. Screening for malignancies after kidney transplantation sounds very important with special attention to the specific environmental and genetic factors in each population

Prediction of rejection in renal transplantation by immune parameters

Monitoring of phenotypic characteristics of T-lymphocytes in peripheral blood is commonly performed to give the clinical parameters in the management of kidney transplant recipients. To predict rejection in renal transplantation by immune parameters. 16 non-diabetic kidney transplant candidates [4 females and 12 males, age = 20-65 yr,-first time transplant] were selected. The transplanted patients were divided into two groups based on the rejection during 3 weeks post transplant: group I [n = 9] without rejection and group II [n = 7] with a rejection episode. Immune parameters including lymphocytes subpopulations [by flowcytometry] and immunoglobulin classes [IgM, IgG, IgA and IgE by nephlometric assay] before and 45 days after transplantation were determined. The results of this investigation showed that the level of immunoglobulin IgG, IgM, IgA and IgE decreased post transplantation due to immunosuppressive drugs. CDS, CD4, CDS T cells count, CD56 NK cells count and CD20 B cells count pre- and post-transplantation did not show any significant differences. The amount of IgE [220 vs. 462 Ill/ml], CDS [62% vs. 69.7%] and CD4 [35% vs. 41.3%] cells increased in group II during rejection episode pre-transplantation. In addition, IgA increased pre-transplantation in group I those without rejection episode in comparison with group II with a rejection episode. Forty five days post transplantation IgA [209 vs. 152 mg/dl], IgG [1009 vs. 703 mg/dl] and CD20 [15% vs. 10%] increased in group 1 patients. It is suggestive that pre-transplantation increases IgE, CDS and CD4 are predictive of acute rejection