Systemic infusion of autologous adipose tissue-derived mesenchymal stem cells in peritoneal dialysis patients: feasibility and safety

Objective: Using mesenchymal stem cells [MSCs] is regarded as a new therapeutic approach for improving fibrotic diseases.The aim of this study to evaluate the feasibility and safety of systemic infusion of autologous adipose tissue-derived MSCs [AD-MSCs] in peritoneal dialysis [PD] patients with expected peritoneal fibrosis

Materials and Methods: This study was a prospective, open-label, non-randomized, placebo-free, phase I clinical trial. Case group consisted of nine eligible renal failure patients with more than two years of history of being on PD. Autologous AD-MSCs were obtained through lipoaspiration and expanded under good manufacturing practice conditions. Patients received 1.2 +/- 0.1×106 cell/kg of AD-MSCs via cubital vein and then were followed for six months at time points of baseline, and then 3 weeks, 6 weeks, 12 weeks, 16 weeks and 24 weeks after infusion. Clinical, biochemical and peritoneal equilibration test [PET] were performed to assess the safety and probable change in peritoneal solute transport parameters

Results: No serious adverse events and no catheter-related complications were found in the participants. 14 minor reported adverse events were self-limited or subsided after supportive treatment. One patient developed an episode of peritonitis and another patient experienced exit site infection, which did not appear to be related to the procedure. A significant decrease in the rate of solute transport across peritoneal membrane was detected by PET [D/P cr=0.77 vs. 0.73, P=0.02]

Conclusion: This study, for the first time, showed the feasibility and safety of AD-MSCs in PD patients and the potentials for positive changes in solute transport. Further studies with larger samples, longer follow-up, and randomized blind control groups to elucidate the most effective route, frequency and dose of MSCs administration, are necessary [Registration Number: IRCT2015052415841N2]

Prevalence of dynapenic obesity and sarcopenic obesity and their associations with cardiovascular disease risk factors in peritoneal dialysis patients

BACKGROUND: Dynapenic obesity and sarcopenic obesity increase cardiovascular disease (CVD) and mortality in nonuremic patients. The present study was designed to determine the prevalence of dynapenic obesity and sarcopenic obesity and their associations with CVD risk factors in peritoneal dialysis (PD) patients. METHODS: All eligible PD patients in Tehran peritoneal dialysis centers were included in this cross-sectional study. Skeletal muscle mass and fat mass were assessed using bioelectrical impedance analysis. Muscle strength and physical performance were determined using hand grip strength and a 4-meter walk gait speed test, respectively. In addition, a 5-mL blood sample was obtained from each patient. RESULTS: The prevalence of dynapenic obesity and sarcopenic obesity were 11.4% and 3.8% in PD patients, respectively. Serum high-sensitive C-reactive protein (hs-CRP), soluble intercellular adhesion molecule type 1, triglyceride, total cholesterol, and low-density lipoprotein cholesterol were significantly higher in PD patients with dynapenic obesity than in dynapenic nonobese and nondynapenic nonobese patients. Similarly, serum concentrations of CVD risk factors in PD patients with sarcopenic obesity were higher than in nonsarcopenic nonobese patients, but these differences were statistically significant only for serum hs-CRP and triglyceride. In addition, muscle strength and skeletal muscle mass percentage were negatively associated with markers of inflammation and dyslipidemia, whereas body fat percentage was positively associated with these CVD risk factors. CONCLUSION: This study indicates that although the prevalence of dynapenic obesity and sarcopenic obesity are relatively low in PD patients, these disorders may be associated with CVD risk factors.

Survival analysis of Iranian patients undergoing continuous ambulatory peritoneal dialysis using cure model

Peritoneal dialysis is one of the most prevalent types of dialysis prescribed to the patients suffering from renal failure. Studies on the factors affecting the survival of these patients have mainly used log-rank test and Cox analysis. The present study aimed to investigate the risk factors affecting short- and long term survival of patients on continuous ambulatory peritoneal dialysis [CAPD] using cure model. The data obtained retrospectively from 20 medical centers in Iran, between 1996 and 2009. All patients with renal failure who had been treated by CAPD and followed at least 3 months were included in the study. The STATA [11.0] software and CUREREGR module were used for survival analysis using cure model. Totally 2006 patients were included in this study. The major reasons for renal failure were hypertension [35.4%] and diabetes [33.6%]. The median of survival time was 4.8 years with a 95% confidence interval of 4.3 to 5.6 years. The percentage of long-lived patients surviving was 40% [95% CI: 32%, 47%]. The analysis showed that the effect of diabetes, serum albumin level, age, diastolic blood pressure, and medical center was significant on the long-term survival of the patients. In addition, in short-term survival the effects of age, albumin, and medical center were significant By improving the quality of medical care in centers, nutritional status, controlling co-morbidities can help the patients on CAPD with better health and increase their short and long term survival

Outcomes of fasciotomy in patients with crush-induced acute kidney injury after Bam earthquake

Fasciotomy may increase the morbidity and mortality in patients with crush-induced acute kidney injury [AKI], by creating an open wound, increasing the risk of bleeding, coagulopathy, and potentially fatal sepsis. This study evaluates the outcomes of fasciotomy in these patients after Bam earthquake in Iran. We reviewed medical records of victims of Bam earthquake complicated with crush-induced AKI. Demographic, biochemical, and clinical data of patients who underwent fasciotomy were evaluated and compared with other patients with AKI. Fasciotomy was performed for 70 of 200 patients with crush-induced AKI [35.0%]. There were no significant differences regarding sex, age, time under the rubble, and muscle enzymes level between these patients and those without fasciotomy. They did not experience higher rates of disseminated intravascular coagulopathy, sepsis, adult respiratory distress syndrome, amputation, and dialysis session. Neither did they have a longer hospitalization period or higher death rate. This study showed that fasciotomy did not have any deteriorating effect on morbidity and mortality of patients with crush-induced AKI after Bam earthquake

Renal involvement in patients with hepatitis c virus infection

Hepatitis C virus [HCV] infection is a hepatotropic virus causing a variety of extrahepatic immunological manifestations and is a risk factor of a variety of extrahepatic diseases, such as mixed cryoglobulinemia and membranoproliferative glomerulonephritis [MPGN], which is the most common glomerulonephritis. The aim of this study was to evaluate renal involvement in HCV-infected patients. A total of 300 randomly-selected HCV antibody-positive outpatients at the HCV clinic of Shariati hospital were enrolled. Serum creatinine was measured and glomerular filtration rate was estimated accordingly. Urine proteinuria was measured in 24-hour urine samples. The patients were 249 men [83.2%] and 51 women [16.8%] with a mean age of 37.8 +/- 11.7 years [range, 18 to 70 years]. Proteinuria was found in 12 HCV antibody-positive adults [4%], 1 of whom underwent biopsy. He was a 55-year-old man with a 4-month history of facial and lower extremities edema and 3-g proteinuria with a normal kidney function [glomerular filtration rate, 85 mL/min] and normocomplementemia. Kidney biopsy specimens showed MPGN. The frequency of low glomerular filtration rate was 0.7% [2 patients] in the HCV antibody-positive adults. There was no significant relationship between HCV seropositivity and low glomerular filtration rate. Our observations showed renal involvement in HCV antibody-positive patients. Among immune complex glomerular kidney diseases, MPGN without cryoglobulins is thought to be the most common in these patients

Frequency, risk factors, and outcome of acute kidney injury following bone marrow transplantation at dr shariati hospital in Tehran

Bone marrow transplantation [BMT] is a major modality for malignant and hematologic disorders. This procedure is associated with a high morbidity and mortality such as acute kidney injury [AKI]. Many factors, such as therapeutic agents, irradiation, and graft versus host disease [GVHD] can cause AKI. Bone marrow transplantation conditioning therapy in Iran is based on drugs such as busulfan and cyclophosphamide and without irradiation therapy. The aim of this study was to evaluate the frequency, risk factors, and mortality of AKI among patients who underwent BMT. Acute kidney injury was defined as doubling serum creatinine from baseline at any time during the first 180 days posttransplant. The risk of AKI in relation to non-total-body-irradiation-based conditioning regimen, type of graft [allograft and autograft], comorbidities, GVHD, drug toxicity, and veno-occlusive disease were examined in 375 patients with BMT. One hundred and forty-two patients [37.6%] developed AKI at a median of 18 days after transplant. A higher frequency of AKI was observed in patients who received cyclosporine A [40%], patients with allograft BMT [42.1%], and those who developed gastrointestinal GVHD [47.3%] .The remainder AKI cases were associated with amphotericin B, veno-occlusive disease, and hemolytic-uremic syndrome. The frequency of AKI in our patients with BMT remained high. Cyclosporine A and amphotericin B and the presence of GVHD and veno-occlusive disease increased the risk of AKI within the first 180 days after BMT

Predictors of patient survival in continuous ambulatory peritoneal dialysis 10-year experience in 2 major centers in Tehran

Many factors have been proposed to be associated with higher mortality in patients on continuous ambulatory peritoneal dialysis [CAPD]. However, the relative importance of these factors may differ among patients with different characteristics. We evaluated survival of patients on CAPD and its influencing factors in Iran. We enrolled 282 patients on CAPD between 1996 and 2006 at 2 major CAPD centers in Tehran. Patient survival was investigated during this period. Demographic characteristics, laboratory data, dialysis adequacy parameters, residual renal function, peritoneal transport characteristics, and nutritional status were assessed as potential predictors of the outcome. The mean duration of follow-up was 18.4 +/- 14.5 months. Sixty patients [21%] died during the studied period. In univariate analysis, age, body mass index, history and duration of hemodialysis before CAPD, diabetes mellitus, blood pressure, patient selection criteria, edema, peritonitis, renal residual function, urine volume, dialysis adequacy, and serum levels of cholesterol, triglyceride, intact parathyroid hormone, calcium, and albumin were predictors of patient survival. Multivariate analysis demonstrated that old age, diabetes mellitus, prior hemodialysis longer than 7 months, low serum albumin, calcium, trigelyceride, and parathyroid hormone levels independently predicted mortality, while the use of angiotensin-converting enzyme inhibitors was associated with a better survival. This study showed that older patients on CAPD and diabetics are at a higher risk of mortality. On the other hand, nutritional and metabolic factors are other predictors of mortality. Especial concern should be applied to good nutrition and treatment of comorbidities in these patients