effects of the underlying disease and serum albumin on GFR prediction using the adaptive neuro fuzzy Inference system [anfis]

Introduction: Kidney disease is a major public health challenge worldwide. Epidemiologic data suggest a significant relationship between underlying diseases and decrease in Glomerular Filtration Rate [GFR]. Clinical studies and laboratory research have shown that the mentioned parameter is effective in development and progression of the renal disease per se. In this study, we used learningbased system based on the neural network concepts

Method: To predict GFR and propose an intelligent method with few errors [about 3%], we need to prognosticate the course and severity of the kidney disease in patients with chronic kidney disease using limited data and information. Adaptive neuro fuzzy inference system [ANFIS] used in the present study is based on the model proposed by Jang, and all laboratory [creatinine, calcium, phosphorus, albumin] and underlying disease caused by chronic kidney disease [CKD] were reviewed

Results: It has been shown that the rate of GFR decreases in patients with diabetes and glomerulopathy was faster than other causes. Furthermore, serum albumin level less than 4.5gr/dl with diabetes was also associated with higher risk of rapid GFR loss

Conclusion:Therefore, it seems that this modeling of fuzzy variables with error less than 3.5% in some cases and create a fuzzy inference system model that presents the complex relationships between the laboratory input variables and GFR as simple linear models

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

Pattern of coronary artery disease risk factors in population younger than 55 years and above 55 years: a population study of 31999 healthy individuals

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

Relationship between the pattern of coronary artery disease risk factors and lipid ratios with five groups of body mass index in 28566 healthy adults

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

Compensated living kidney donation in Iran: donor's attitude and short-term follow-up

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. 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. 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. 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

Changing epidemiology of end-stage renal disease in last 10 years in Iran

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. 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. 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. 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

Pulmonary hypertension and predisposing factors in patients receiving hemodialysis

The aim of this study was to evaluate the frequency of unexplained pulmonary hypertension [PHT] among patients on hemodialysis at 2 centers and to evaluate possible predisposing factors. In this cross-sectional study, PHT was screened by Doppler echocardiography on the day after dialysis in 62 patients with end-stage renal disease receiving maintenance hemodialysis via arteriovenous access. Pulmonary hypertension was defined as a systolic pulmonary arterial pressure [PAP] higher than 35 mm Hg, and the systolic PAP was calculated using the modified Bernoulli equation. Clinical variables were compared between patients with and without PHT. A PAP higher than 35 mm Hg was found in 32 patients [49.3%] receiving hemodialysis, with a mean systolic PAP of 39.58 +/- 13.27 mm Hg. Blood hemoglobin level was significantly lower in the patients with PHT than those without PHT [9.8 +/- 1.97 g/dL versus 11.07 +/- 1.86 g/dL; P = .01]. In addition, serum levels of albumin was lower in these patients [3.38 +/- 0.32 g/dL versus 3.75 +/- 0.44 g/dL; P = .02]. This study demonstrates a surprisingly high prevalence of PHT among patients with end-stage renal disease receiving hemodialysis. We concluded that the best approach to this unrecognized complication that is associated with reduced survival is keeping it in mind and looking for it in the management of patients on dialysis

Management of calcium and phosphorus metabolism in hemodialysis patients in Tehran province, Iran

Our aim was to evaluate the degree of achievement of the recommended values in National Kidney Foundation Dialysis Outcomes Quality Initiative [K/DOQI] guidelines for the laboratory indicators of bone metabolism in patients undergoing hemodialysis [HD] in Tehran province. We evaluated the laboratory information of 2630 HD patients in Tehran province. Demographic data of the patients and the clinical information including the duration of dialysis session, dialysate calcium concentration, Kt/V, and serum values of calcium, phosphorus, and intact parathyroid hormone [PTH] were recorded. The laboratory values were compared to the recommended ranges by the K/DOQI work group in patients with end-stage renal disease. Only 1.8% of the patients could enjoy a successful management according to the K/DOQI recommendations for the 4 target laboratory tests of serum calcium, phosphorus, intact parathyroid hormone, and calcium-phosphorus product. Hypocalcemia was diagnosed in 33.2% of the patients, whereas 13.6% were diagnosed with hypercalcemia. Hypophosphatemia and secondary hyperparathyroidism were diagnosed in 6.8% and 24.2% of the patients, respectively. Our findings proved that complying with the recommendations established by the K/DOQI work group in the clinical management of mineral metabolism is very demanding. Phosphate binders frequently lead to untoward toxicities and imbalance in bone metabolism of patients on HD, warranting new cost-effective therapies with fewer side effects. It would be of great interest to analyze, in the future, the benefits derived from the effect of new therapies such as calcimimetics or new phosphate binders regarding the achievement of the K/DOQI guidelines

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

Prevalence of cutaneous manifestations in end stage renal disease patients under hemodialysis in Imam Khomeini hospital, Tehran in 2003

New modalities in the treatment of end-stage renal disease [ESRD] patients have increased their life expectancy and quality of life. A wide range of cutaneous manifestations are seen in ESRD patients. This study was conducted to determine the prevalence of cutaneous manifestations in ESRD patients on maintenance hemodialysis in the dialysis department of Imam Khomeini hospital. One hundred and four hemodialysis patients on maintenance hemodialysis in April, May, and June 2003 were interviewed and examined for skin problems. Almost all patients had at least one cutaneous lesion. The most common cutaneous findings were changes in skin color and nail disorders [79.8%]. The other common cutaneous manifestations were xerosis [74%] and pruritus [51%]. Xerosis was more common in those patients with serum calcium level greater than 9.3 gr/dl [P<0.05]. Hyperpigmentation was more frequent in patients with urine volume <500 ml [P<0.05] and in those who were more than 24 months on continuous hemodialysis [P<0.05]. Pruritus was more common in those patients with a history of drinking alcohol [P<0.05]. Nail involvement was seen in all 14 patients who were positive for HCV Ab, but was absent in those 5 patients who were positive for HBs Ag. Cutaneous manifestations are very common in ESRD patients on maintenance hemodialysis