Limited knowledge of chronic kidney disease and its main risk factors among Iranian community: an appeal for promoting national public health education programs

The aim of this survey was to explore the baseline knowledge of the Iranian community about Chronic Kidney Disease [CKD] definition and its two main risk factors, i.e. diabetes and hypertension. This study also introduced a model of public education program with the purpose of reducing the incidence of CKD in high-risk groups and thereby decreasing the economic burden of CKD in Iran. This cross-sectional study was conducted on world kidney day 2013 in Isfahan, Iran. Self-administered anonymous questionnaires evaluating the knowledge of CKD and its risk factors were distributed among subjects who participated in a kidney disease awareness campaign. Chi-square test and logistic regression analysis were used to examine the differences in the level of knowledge across different socio-demographic groups. The questionnaires were completed by 748 respondents. The majority of these respondents believed that "pain in the flanks" and "difficulty in urination" was the early symptoms of CKD. Roughly, 10.4% knew that CKD could be asymptomatic in the initial stages. Only 12.7% knew diabetes and 14.4% knew hypertension was a CKD risk factor. The respondents who had a CKD risk factor [i.e. diabetes and/or hypertension] were significantly more likely than respondents without CKD risk factor to select "unmanaged diabetes" [Odds Ratio [OR]= 2.2, Confidence Interval [CI] [95%]: 1.4-3.6] and "unmanaged hypertension" [OR= 1.9, CI[95%]: 1.2-3.0] as "very likely to result in CKD". No more than 34.6% of all respondents with diabetes and/or hypertension reported that their physician has ever spoken with them about their increased risk for developing CKD. The knowledge of Iranian population about CKD and its risk factors is low. Future public health education programs should put efforts in educating Iranian community about the asymptomatic nature of CKD in its initial stages and highlighting the importance of regular renal care counseling. The high-risk individuals should receive tailored education and be encouraged to adopt lifestyle modifications to prevent or slow the progression of CKD

Response: Association of Vaspin with Metabolic Syndrome: The Pivotal Role of Insulin Resistance (Diabetes Metab J 2014;38:143-9)

No abstract available.

Association of Vaspin with Metabolic Syndrome: The Pivotal Role of Insulin Resistance

BACKGROUND: Previous studies evaluating the relationship between serum vaspin concentrations and metabolic syndrome (MetS) have yielded contrasting results. Additionally, contribution of general and abdominal obesity, chronic inflammation, and insulin resistance to this relationship remains unknown. METHODS: In a cross-sectional setting, we investigated the association between vaspin and MetS in 145 subjects ranging from normoglycemia to type 2 diabetes. Vaspin concentrations were measured using enzyme-linked immunosorbent assay. RESULTS: Women had 29% higher vaspin concentrations compared with men. Subjects with MetS (51% of all participants) had higher vaspin concentrations (P=0.019 in women and P<0.001 in men). In logistic regression, vaspin significantly predicted raised fasting plasma glucose (P<0.001), and raised triglycerides (P<0.001) after controlling for age in both sexes. Moreover, vaspin was the significant predictor for reduced high-density lipoprotein cholesterol and raised waist circumference in women and men, respectively. Considering MetS as a whole, vaspin predicted MetS even after adjustment for age, medications, diabetes, total cholesterol, and waist circumference in both sexes (odds ratio [OR], 3.88; 95% confidence interval [CI], 1.36 to 11.05; P=0.011 for women; OR, 3.16; 95% CI, 1.28 to 7.78; P=0.012 for men). However, this relationship rendered nonsignificant after introducing homeostasis model assessment of insulin resistance (HOMA-IR) in women (P=0.089) and high-sensitivity C-reactive protein (P=0.073) or HOMA-IR in men (P=0.095). CONCLUSION: Vaspin is associated with some but not all components of MetS. Vaspin is a predictor of MetS as a single entity, independent of obesity. This relationship is largely ascribed to the effects of insulin resistance and chronic inflammation.

effects of simvastatin on the serum concentrations of thyroid stimulating hormone and free thyroxine in hypothyroid patients treated with levothyroxine

Statins, such as simvastatin, are the drugs of choice for the treatment of hypercholesterolemia. On the other hand hypercholesterolmia can occur in hypothyroid patients, who receive levothyroxine. There are few clinical case reports in regards to drug interaction between levothyroxine and lovastatin or simvastatin, indicating decreased levothyroxine effects. This study aimed at determining possible interaction between simvastatin and levothyroxine in hypothyroid patients by assessing serum levels of thyroid stimulating hormone [TSH] and free thyroxine [FT4], the two important laboratory indices for levothyroxine therapy. In a cross sectional study, 41 eligible hypothyroid patients receiving levothyroxine [50-150 micro g/d] were selected. Blood samples were taken before and after three months of simultaneous treatment with simvastatin [20 mg/d] and levothyroxine to determine the serum levels of TSH and FT4. There was no significant difference between the serum levels of TSH [P=0.77] or FT4 [P=0.76] before and after three months of simultaneous treatment. Also, there was no aggravation or initiation of any sign or symptom of hypothyroidism in the patients during the study period. Considering that FT4 and TSH are the most reliable indicators for the levothyroxine treatment, the findings of the present study suggest that there may not be any significant interaction between simvastatin and levothyroxine

Angiotensin Converting Enzyme Gene polymorphism in Iranian Patients with Type 2 Diabetes

Angiotensin I converting enzyme [ACE] is a Zinc metalloproteinase, converts Ang I to Ang- IIa pro-inflammatory agent which may contribute to pathophysiology of some diseases like type 2 diabetes. To investigate the relationship between ACE I/D polymorphism and type 2 diabetes in 261 Iranian casecontrol pairs. 170 patients [85 type 2 diabetics with nephropathy and 85 type 2 diabetics without nephropathy] and 91 healthy control subjects were enrolled in our study. I/D polymorphism of the ACE gene was detected by polymerase chain reaction [PCR] utilizing specific primers. The frequency of DD genotype in the DN group was higher than that of the type 2 diabetic patients [30.6% vs. 20%, P = 0.157] and the control group [30.6% vs. 14.3%, P=0.006]. The frequency of D allele in nephropathic patients was 58.2% as compared to type 2 diabetic patients without nephropathy 50.5% [P=0.19] and control subjects 37.3% [P =0.001]. Therefore, the frequency of DD genotype and D allele significantly increased in DN patients in comparison to healthy controls. It is concluded that the DD genotype and /or D allele of ACE gene may increase the risk for type 2 diabetes but not diabetic nephropathy

Prevalence of diabetic patients among under hemodialysis patients in ten hemodialysis centers of Tehran

Diabetic nephropathy is a leading cause of end-stage renal disease [ESRD] in developed countries. This study was designed to determine the proportion of the diabetic patients among under-hemodialysis patients in ten hemodialysis centers of Tehran. This descriptive, cross-sectional study was done on all under-hemodialysis patients of ten hemodialysis centers [620 patients] during 2001-2002. Data were collected by taking history of the patients and reviewing their medical records. The data were analyzed to find out the frequency of the diabetes and the risk factors associated with diabetic nephropathy such as age, sex, type and duration of diabetes, smoking, hypertension, dyslipidemia, ischemic heart disease and the family history of diabetes and hypertension. Diabetes was the cause of ESRD in 25% of patients aged 32 to 89 years old. The most frequent age group was 7th decade. 9% of diabetic patients suffered from type 1 and 91% of them suffered from type 2 diabetes. Patients with the diabetes duration of 15-19 years had the most frequency. 40% of patients were female and 60% of them were male. History of hyperglycemia, hypertension, dyslipidemia, ischemic heart diseases and smoking were positive in 48%, 82.5%, 46%, 41%, and 21% of patients, respectively. The results of this study are in agreement with other studies in this field. Diabetic patients compose a remarkable percentage of under-hemodialysis-patients. High frequency of risk factors in these patients should promote controlling them to prevention ESRD

Diabetes mellitus following pituitary adenomectomy in euglycemic patients with acromegaly

Insulin resistance, impaired glucose tolerance and diabetes mellitus [DM] secondary to acromegaly generally improve following treatment of the underlying disease. In rare cases, in spite of normoglycaemia in the presence of active acromegaly, patients develop diabetes mellitus following pituitary adenomectomy to the extent of requiring insulin therapy. We report 7 patients who developed diabetes mellitus after pituitary adenomectomy. Regular measuring of blood glucose in post-pituitary surgery patients is recommended as a necessary step even in the previously normoglycaemics