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

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