Carotid intima-media thickness in maintenance hemodialysis patients role of cardiovascular risk factor

Carotid intima-media thickness [CIMT] has been introduced as a cardiovascular disease predictor which may increase in hamodialysis patients. As there are many risk factors in the uremic state that theoretically lead to increase in CIMT, this study was aimed to determine risk factors of CIMT increase in a group of hemodialysis patients. Seventy-two hemodialysis patients with a mean age of 61.3 +/- 15.0 years and 49 individuals with no history of chronic disease [control group] underwent ultrasonography for measurement of CIMT. Correlation of demographic, clinical, and laboratory factors with CIMT was studied. Carotid intima-media thickness was measured by one radiologist in the bilateral common carotid artery, and the mean value of the two sides was reported. The mean duration on dialysis was 82.4 +/- 78.0 months. The mean CIMT was 0.96 +/- 0.25 mm [range, 0.4 to 1.7 mm] in hemodialysis patients and 0.76 +/- 0.06 mm [range, 0.58 to 0.91 mm] in the control group [P < .001]. The mean CIMT was significantly higher in men compared to women on dialysis and in diabetic compared to nondiabetics patients. There was a positive correlation between CIMT and age [r=0.266, P=.02] and serum cholesterol [r=0.375, P=.002]. No correlation was found between CIMT and other studied variables. Carotid intima-media thickness was greater in hemodialysis patients compared to the control group. It was mainly affected by traditional cardiovascular risk factors and uremic risk factors did not specifically affect CIMT

PDpoietin in comparison with eprex in treatment of anemic patients on hemodialysis

PDpoietin is a recombinant erythropoietin alfa that has been introduced by a manufacturer in Iran. We assessed the effectiveness and complications of PDpoietin in comparison with Eprex in anemic patients on hemodialysis. This clinical trial was performed in a multicenter setting. Patients with a hemoglobin level less than 12 g/dL were assigned into 2 groups in order to receive either Eprex [Janssen Cilag] or PDpoietin [Pooyesh Darou] for 3 months. Forty-one and 34 patients completed the study in the PDpoietin and Eprex groups, respectively. The mean hemoglobin levels at baseline were not significantly different between the two groups of patients with PDpoietin and Eprex. In both groups, hemoglobin levels increased significantly, but there were no significant differences between the two groups at months 1, 2, and 3. At the end of the study, the mean hemoglobin levels reached 11.6 +/- 1.7 g/dL and 11.8 +/- 1.9 g/dL, respectively [P = .002; P = .01]. The mean hemoglobin per cumulative of drug dose index [hemoglobin/[erythropoietin dose/1000 x injections per month]] was not significantly different between the two groups at different treatment stages, and it did not change significantly in each group during the course of the study. No serious complications were reported. Eprex and PDpoietin could equally increase the hemoglobin levels with no significant complication. Therefore, PDpoietin can be used for treatment of anemia in patients on dialysis, and the patients will have the advantages of its availability and low price

Different doses of oral folic acid for homocysteine-lowering therapy in patients on hemodialysis a randomized controlled trial

We compared the effect of higher and lower doses of folic acid compared to our routine daily dose on plasma homocysteine levels, in our hemodialysis patients. Eighty patients on hemodialysis receiving oral folic acid, 10 mg/d, were randomized to receive folic acid at either doses of 5 mg/d [group 1] or 15 mg/d [group 2] for 2 months. Plasma levels of total homocysteine were measured before and after the study period. Hyperhomocysteinemia was seen in 75 patients [93.8%] before, and in 37 patients of group 1 [92.5%] and 39 of group 2 [97.5%] after the study period. In group 1, a nonsignificant decrease occurred in plasma homocysteine level [29.67 +/- 12.26 micro mol/L to 27.78 +/- 9.94 micro mol/L, P = .30], while in group 2, there was a significant decrease in homocysteine level [32.40 +/- 9.76 micro mol/L to 29.58 +/- 9.62 micro mol/L, P = .01]. Changes in homocysteine level correlated with its baseline level [r = -0.42, P < .001]. In both groups, significant reductions in homocysteine level were seen mostly in those patients with high baseline homocysteines. Routine folic acid supplementation of 10 mg/d could not normalize plasma homocysteine levels in most of our patients. Increasing folic acid dose made a statistically significant but clinically trivial decrease in homocysteine levels, and could not normalize homocysteine level in most patients. Patients with a higher baseline homocysteine level achieved a greater reduction, which may be explained by primary noncompliance of some patient. Further investigation of folic acid dosage is suggested

Posttransplant diabetes mellitus in kidney allograft recipients at Shaheed Hasheminejad Hospital

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. 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. 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. 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

Peritoneal dialysis past, present, and future

Approximately, 10% to 15% of patients with end-stage renal disease are on peritoneal dialysis [PD] worldwide, with a dramatic difference in the use of PD among various countries. Recent data show a survival benefit of PD over hemodialysis which is maintained up to the 3rd year. The quality of life studied by various models is as good as, if not better than, that in patients on hemodialysis, for at least the first 2 years. In most countries that locally manufacture PD solutions, PD is significantly cheaper than hemodialysis. Several studies have found a better immediate graft function, lower rate of delayed graft function, and lower use of immunosuppressive medication after kidney transplantation in patients previously on PD compared to those on hemodialysis. There is a significantly lower rate of hepatitis C and hepatitis B infections in patients on PD compared to those on hemodialysis. Longer maintenance of residual renal function in PD compared to hemodialysis adds to the lower morbidity and the survival benefit of PD mentioned above. Many developments in the prevention of the causes of technique failure, including measures to prevent serious peritonitis episodes and new biocompatible PD solutions, together with the possible advantages of some types of catheters and implantation techniques, encourage us to believe that we can offer successful long-term PD in the near future. Overall, the new insight into the pathogenesis of peritoneal membrane changes, the response of the industry to this knowledge by producing new biocompatible PD solutions, the decrease in the peritonitis rate and the introduction of assisted PD at home encourages us to believe that the future of PD is indeed bright