Prevalence of chronic kidney disease and its contributing risk factors in southern Iran: a cross-sectional adult population-based study.

INTRODUCTION: The global prevalence of chronic kidney disease (CKD) is increasing consistently. Progression of CKD to end-stage renal disease could be slowed down by early detection and treatment, yet CKD and its risk factors have been poorly studied in many countries. This study investigated the CKD prevalence and its contributing risk factors in adult population of Southern Iran. MATERIALS AND METHODS: In this cross-sectional study on randomly recruited participants from adult population, we investigated the CKD prevalence (stages 3 to 5) and its risk factors in Southern Iran. After calculation of sample size (10385 cases), data was collected in a total of 10397 individuals. Medical and demographic data was obtained, as well as measurement of height, body weight, blood pressure, and blood urea nitrogen, and serum creatinine. A fresh spot urinalysis was also performed. RESULTS: The overall prevalence of CKD stages 3 to 5 was 11.6%. Stages 1, 2, 3, 4, and 5 of CKD were found in 8.5%, 66.1%, 11.4%, 0.1%, and 0.1% of the participants, respectively. The prevalence of CKD (stages 3 to 5) was significantly higher compared to those with the non-CKD group, in the older than younger participants, and in the women as compared to the men. There was a strong positive correlation between age, female sex, hypertension, and high body mass index with different stages of CKD. CONCLUSIONS: The prevalence of CKD is high in Southern Iran and its contributing risk factors are older age, female sex, hypertension, and high body mass index.

Prevalence of chronic kidney disease and its related risk factors in elderly of southern iran: a population-based study.

Aim. The prevalence of chronic kidney disease (CKD) as a serious public health problem is growing in the elderly. This study aimed to assess CKD prevalence and its related risk factors in elderly population of Fars province. Methods. In this cross sectional study a total of 1190 elderly people are enrolled, and demographic and medical data were obtained. Data were analyzed by SPSS, and P of less than 0.05 was considered as statistically significant. Results. Prevalence of CKD stages III-V was 27.5% in the 60-69 years age group, 36.5% in the 70-79 years age group, and 40% in the ≥80 years age group. The prevalence of CKD increased with ageing in both men and women. Female gender was the strongest risk factor for CKD. Conclusions. Prevalence of CKD in elderly is high in Southern Iran, which has become an important health problem while it can be prevented or delayed in progression.

Oral supplementation of turmeric decreases proteinuria, hematuria, and systolic blood pressure in patients suffering from relapsing or refractory lupus nephritis: a randomized and placebo-controlled study.

OBJECTIVE: Despite highly expensive treatments, lupus nephritis remains a major cause of morbidity and mortality in patients with relapsing or refractory lupus nephritis. Meanwhile, experimental studies indicate that curcumin attenuates both the binding of autoantibodies from systemic lupus erythematosus patients to their cognate antigens and also the inflammatory responses of tumor necrosis factor-alpha-stimulated human endothelial cells. Therefore, in this study we investigated effect(s) of oral curcumin supplementation on patients suffering from relapsing or refractory lupus nephritis. DESIGN: A randomized and placebo-controlled study was carried out. SETTING: The present study was conducted in Lupus clinic of Hafez Hospital, Out-Patient Department of Shiraz University of Medical Sciences. PATIENTS: A total of 24 patients with relapsing or refractory biopsy-proven lupus nephritis, who were randomized in 2 groups (trial [n = 12] and control [n = 12] groups) were included in this study. INTERVENTION: With each meal, each patient in the trial group received 1 capsule for 3 months, which contained 500 mg turmeric, of which 22.1 mg was the active ingredient curcumin (3 capsules daily). The control group received 3 capsules (1 with each meal) for the same period, which contained starch and were identical in color and size to capsules given to patients in the trial group. MAIN AUTOMATIC MEASURE: Data were analyzed using Statistical Package for the Social Sciences software version 15.0. RESULTS: A significant decrease in proteinuria was found when comparing pre- (954.2 ± 836.6) and 1, 2, and 3 months supplementation values (448.8 ± 633.5, 235.9 ± 290.1, and 260.9 ± 106.2, respectively) in the trial group. Also, systolic blood pressure and hematuria were found to decrease significantly when pre- and post-turmeric supplementation values were compared in the trial group. However, placebo capsules did not exert any statistically significant effect on measured variables in the control group over 3 months of the study. No adverse effect related to turmeric supplementation was observed during the trial. CONCLUSION: Short-term turmeric supplementation can decrease proteinuria, hematuria, and systolic blood pressure in patients suffering from relapsing or refractory lupus nephritis and can be used as an adjuvant safe therapy for such patients.

Turmeric: Reemerging of a neglected Asian traditional remedy.

CONTEXT: Turmeric (Curcuma longa) is a wild plant of the ginger family native to tropical South Asia. EVIDENCE ACQUISITIONS: Directory of Open Access Journals (DOAJ), Google Scholar, Pubmed (NLM), LISTA (EBSCO) and Web of Science have been searched. RESULTS: Emerging evidence indicate that turmeric/curcumin inhibits cytokines and TGF-ß production. From the various factors involved in the genesis of chronic kidney disease and pathogenesis of primary and secondary glomerulonehritis, TGF-ß has emerged as a key factor in the cascade of events. Leading to glomerulosclerosis, tubulointerstitial fibrosis and end-stage renal disease. CONCLUSIONS: considering the inhibitory effect of turmeric/curcumin on cytokines and TGF-ß, it seems wise to assume that supplementary turmeric/curcumin might be a candidate remedy for chronic kidney disease and possibly prevention of subsequent end stage renal disease.

Oral supplementation of turmeric attenuates proteinuria, transforming growth factor-ß and interleukin-8 levels in patients with overt type 2 diabetic nephropathy: a randomized, double-blind and placebo-controlled study.

OBJECTIVE: End-stage renal disease (ESRD) due to type 2 diabetic nephropathy is a very common condition which is increasing in prevalence, and is associated with high global levels of mortality and morbidity. Both proteinuria and transforming growth factor-ß (TGF-ß) may contribute to the development of ESRD in patients with diabetic nephropathy. Experimental studies indicate that turmeric improves diabetic nephropathy by suppressing TGF-ß. Therefore, this study investigated the effects of turmeric on serum and urinary TGF-ß, interleukin-8 (IL-8) and tumour necrosis factor-α (TNF-α), as well as proteinuria, in patients with overt type 2 diabetic nephropathy. MATERIAL AND METHODS: A randomized, double-blind and placebo-controlled study was carried out in the Diabetes Clinic of the Outpatient Department of Shiraz University of Medical Sciences on 40 patients with overt type 2 diabetic nephropathy, randomized into a trial group (n = 20) and a control group (n = 20). Each patient in the trial group received one capsule with each meal containing 500 mg turmeric, of which 22.1 mg was the active ingredient curcumin (three capsules daily) for 2 months. The control group received three capsules identical in colour and size containing starch for the same 2 months. RESULTS: Serum levels of TGF-ß and IL-8 and urinary protein excretion and IL-8 decreased significantly comparing the pre- and post-turmeric supplementation values. No adverse effects related to turmeric supplementation were observed during the trial. CONCLUSION: Short-term turmeric supplementation can attenuate proteinuria, TGF-ß and IL-8 in patients with overt type 2 diabetic nephropathy and can be administered as a safe adjuvant therapy for these patients.

Comparison of risk factors for contrast-induced acute kidney injury between patients with and without diabetes.

Although it is well known that diabetics are at a higher risk of contrast-induced acute kidney injury (CI-AKI) than nondiabetic patients, the reason for this discrepancy is not well known. Thus, in this study, we compared the predisposing factors for CI-AKI between patients with and without diabetes. We prospectively studied 290 consecutive in-hospital patients including 88 diabetics undergoing coronary angiography or a percutaneous coronary intervention in Kowsar hospital, and we compared risk factors for CI-AKI between diabetic and nondiabetic patients. CI-AKI was defined as RIFLE criteria within 48 hours after contrast exposure. The incidence of CR-AKI was significantly higher in diabetic patients compared with nondiabetics (P<0.05). The incidence of CI-AKI was significantly higher in patients with diabetes and left-ventricular ejection fraction ≤40%, hypercholesterolemia, serum creatinine ≥1.1 mg/dL, estimated glomerular filtration rate (eGFR) <90 mL/min, Contrast volume ≥80 (mL), maximum safe contrast volume factor of 1.5, and dehydration, while in nondiabetics, a significantly higher incidence of CR-AKI was observed in those with serum creatinine ≥1.1 mg/dL (P=0.02) and/or eGFR<60 mL/min (P=0.01). Multiple logistic regression analysis showed hyperchlosteremia to be the strongest predictor of AKI (P=0.01, B:14.5) in diabetics, followed by eGFR<90 (P=0.05, B:12.4) but, in nondiabetics, only eGFR<60 predicted the occurrence of CI-AKI (P=0.04, B:2.3). It seems that the predisposing factors to CI-AKI differ in diabetics and nondiabetics. In patients with diabetes, hypercholesterolemia is the strongest predictor of CI-AKI, followed by eGFR and diabetics are at risk for CI-AKI in the early stage of chronic kidney disease (stage 2), accounting for the higher incidence of CI-AKI in them.

Causes of chronic renal failure among Iranian hemodialysis patients.

Chronic renal failure (CRF) is characterized by impaired renal function, which is progressive and irreversible. This study was carried out to investigate the status and causes of CRF in HD patients in Fars Province, Iran. In this cross-sectional study, HD patients were evaluated in Fars province. Information for demographic characteristics, and medical history were obtained by using a questionnaire administered by trained staff. 633 cases including 371 male and 262 female were studied. The mean KT/V was 1 0.4. KT/V > 1.2 was achieved in only 32.1% (203/633) of all patients. The mean BMI was 24 +/- 4.5. The most common causes of CRF were hypertension (30.5%) and diabetes mellitus (30.1%). In conclusion most common causes of CRF in this region were hypertension and diabetes mellitus. Better management of hypertension and diabetes could prevent patients from ending up with end stage renal disease.

A comparison of sodium bicarbonate infusion versus normal saline infusion and its combination with oral acetazolamide for prevention of contrast-induced nephropathy: a randomized, double-blind trial.

BACKGROUND: Contrast-induced nephropathy (CIN) is commonly encountered. Because the therapy of choice for prevention of CIN is controversial, in this study we compared the preventive efficacy of bicarbonate (Bi) infusion in dextrose water versus normal saline (NLS) infusion alone or in combination with oral acetazolamide (AZ). METHODS: In a double-blind and randomized clinical trial, all patients undergoing coronary angiography or percutaneous coronary intervention received NLS (NLS group), its combination with AZ (AZ group) or infusion of Bi (Bi group) before the procedures. RIFLE (risk of renal failure, injury to the kidney, failure of kidney function, loss of kidney function, and end-stage renal disease) criteria were used to define CIN-associated acute kidney injury (AKI). RESULTS: The risk of AKI in CIN was significantly lower in the Bi and AZ groups than in the NLS group (P 0.05). CONCLUSIONS: It seems that both Bi and AZ reduce the risk of CIN-related AKI, and close monitoring of serum potassium is needed during bicarbonate infusion.

Effect of oral calcitriol pulse therapy on the lipid, calcium, and glucose homeostasis of hemodialysis-patients: its safety in a combination with oral calcium carbonate.

OBJECTIVE: To more clearly elucidate the conflicting results that have been obtained after oral calcitriol pulse therapy on lipid, glucose, and calcium levels in hemodialysis (HD) patients, and to determine safety of oral calcitriol pulse therapy in a combination with calcium carbonate. DESIGN: A randomized, crossover, placebo-controlled study. SETTING: HD centers in 3 teaching university hospitals. PATIENTS: Forty-eight chronic HD patients. METHODS: HD patients were randomized into 2 groups. Each group (n = 24), in addition to 4.5 g calcium carbonate daily, received either oral calcitriol pulse therapy or placebo twice weekly at the end of HD, sessions for 3 months, after which the 2 therapeutic groups were crossed-over, and for an additional 3 months, the calcitriol group received placebo, and the placebo group was put on calcitriol. Serum triglyceride, total cholesterol, low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), total calcium, alkaline phosphatase, proteins, phosphorus, parathyroid hormone (PTH), blood pH, and glucose were measured at random and at the end of 3 and 6 months of the trial. RESULTS: After calcitriol therapy, triglyceride, serum PTH, total alkaline phosphatase, and fasting blood sugar significantly decreased, but total serum calcium significantly increased, whereas other examined parameters remained unchanged compared with the other groups. Calcium, phosphorus, calcium x phosphorus product, PTH levels, and all of these parameters were optimized in 18 (37.5%), 22 (45.8%), 34 (70.8%), 30 (62.5%), and 12 (%25) cases, respectively, in the calcitriol groups. No significant side effect was seen during the trial. CONCLUSION: Our findings indicate that short-term oral calcitriol pulse therapy in combination with calcium carbonate is safe and beneficial for metabolic abnormalities of HD patients; however, its safety for prolonged therapy is yet to be proved.