Carotid Intima-media Thickness in Hemodialysis Patients and Related Biochemical and Clinical Factors.

INTRODUCTION: Cardiovascular complications are the most frequent cause of death in chronic kidney disease that happens due to both general and uremic risk factors. Recently, the medical literature has declared the carotid artery intima-media thickness to be an indicator for predicting cardiovascular diseases. METHODS: This paper is an attempt to introduce an analytical cross-sectional study of 128 hemodialysis patients. The researchers collected the data by reviewing medical records, interviewing the patients, chemical analysis of the patient's serum and carotid artery Doppler ultrasound, and providing the relevant questionnaire. We performed descriptive statistics, bivariate correlation, and general linear model (GLM) analysis. And, the significance level of hypothesis tests was .05. RESULTS: Seventy-three patients (57%) were male, and 55 (43%) were female. The mean and standard deviation of the age was 58.66 ± 15.54 years. Nearly 42% of patients affected by diabetes, 95.3% were hypertensive and 28.1% had a history of cardiovascular disease. In the bivariate analysis, age, serum albumin, serum magnesium, hypertension, and history of cardiovascular disease showed a statistically significant relationship with carotid intima-media thickness (CIMT). In GLM, we observed a statistically significant relationship between CIMT, age and magnesium. CONCLUSION: Increased CIMT is observed in a considerable percentage of hemodialysis patients. Age and serum magnesium concentration demonstrate a statistically significant association with CIMT. We recommend more precise long-term longitudinal follow-up studies to investigate the relationship between biochemical risk factors and CIMT. Therefore, multivariate analysis is necessary to assess the simultaneous effects of independent variables and manage influences of confounding factors. We also recommend developing a practical guideline for periodic determination of CIMT in hemodialysis patients to implement convenient preventive or therapeutic measures.  DOI: 10.52547/ijkd.7303.

Missed bladder rupture following vaginal delivery: Possible role of assessing ascitic fluid creatinine levels?

Bladder injury is the most common urological trauma following the gynecological procedure. Normal vaginal delivery candidates with unresponsive and prolonged ascites and bladder-emptying complaints should be examined for bladder rupture. We also suggest measurement of ascitic fluid creatinine levels in these patients.

The Application of Urinary NGAL Measurement for Early Detection of AKI in Hospitalized Patients with Poisoning.

INTRODUCTION: Early diagnosis of acute kidney injury is critical for decision-making. Neutrophil gelatinase-associated lipocalin (NGAL) is a biomarker introduced for early detection of acute kidney injury (AKI). We evaluated urinary NGAL level in hospitalized patients due to poisoning as a predictor of AKI. METHODS: We studied patients with poisoning due to various causes. Urinary NGAL and urine creatinine levels were measured. Serum creatinine levels were measured for all patients at baseline and after 24 and 48 hours. Then, a ROC curve developed for urinary NGAL, and cutoff point and accuracy of urinary NGAL test were determined. RESULTS: Ninety hospitalized patients with acute poisoning were consecutively recruited into the study over an eight-months period. With the gold standard test (i.e., serum creatinine measurement), 21 patients were diagnosed with acute kidney injury (AKI) and 69 with non-AKI, whereas according to ROC curve, at a cutoff point of 110 ng/ml, urinary NGAL with an 81% sensitivity and 91.3% specificity distinguished 23 patients with AKI and 67 with non- AKI. The false positive and false negative values of urinary NGAL test were 8.7% and 19%, respectively. The positive predictive value and negative predictive value of urinary NGAL were estimated to be 73.9% and 94%, respectively. CONCLUSION: Urinary NGAL test, with an AUC of ROC curve of approximately 90% and a sensitivity of 81%, can be used for early detection of AKI. It has a high specificity (91.3%), indicating that the percentage of false positive cases (8.7%) will be small.

Study of Urine Composition of Patients With Recurrent Nephrolithiasis in Lorestan, Iran.

INTRODUCTION: Nephrolithiasis is one of the most common urinary tract diseases. After the first episode of urinary calculus, the risk of recurrence is nearly 40% to 50% at 5 years. Nephrolithiasis is a systemic disease that is associated with some metabolic disorders. This study aimed to provide a picture of the frequency of metabolic abnormalities in patients with nephrolithiasis from west part of Iran. MATERIALS AND METHODS: Patients with recurrent urinary tract calculi referred to the Nephrology-Urology Clinics in Khorramabad city were recruited. After collection of demographic data of all the patients, 24-hour urine and blood samples were taken to measure biochemical factors. RESULTS: Of the 232 participants, 125 were males and 107 were females. Hyperoxaluria was seen in 93 (40.1%) of the participants, hypercalciuria in 55 (23.7%), hypocitraturia in 58 (25%), and hyperuricosuria in 33 (14.9%). Hyperoxaluria in the males was significantly more frequent than in the female patients. There were no significant differences between the two groups in other urinary metabolic disorders. CONCLUSIONS: Patients with nephrolithiasis from Lorestan province may have metabolic characteristics varying from those of regions; ethnicity may be a possible reason. Variation of dietary regimens, such as the amount of meat or vegetable in the diet that can change oxalate, calcium, or citrate of urine, might have influenced the results. Time of sampling is another factor. Population-specific studies are helpful to health care providers for preventive planning for nephrolithiasis.

Administration of pentoxifylline to improve anemia of hemodialysis patients.

Introduction: One of the most important causes of erythropoietin-resistant anemia in end-stage renal disease (ESRD) patients is increased levels of inflammatory cytokines. Objectives: In this study pentoxifylline, an anti-inflammatory and anti-cytokine drug, with no significant side effects was used to manage anemia in ESRD patients. Patients and Methods: Thirty-nine ESRD patients with erythropoietin-resistant anemia were assigned to two groups, the treatment and the control groups. In treatment group, 19 patients received erythropoietin, venofer and pentoxifylline for 6 months. Patients in control group received erythropoietin and venofer. Hemoglobin (Hb), hematocrit (Hct), albumin and quantitative C-reactive protein (CRP) were measured at the beginning of the study, monthly and at the end of the study. Results: Hb and Hct were significantly increased in the treatment group (9.33±1.25 g/dL and 28.08±3.88% at baseline; 11.22 ± 1.26 g/dL and 34.02 ± 3.72% at sixth month, P = 0.01), but not in the control group. CRP was significantly decreased in the treatment group but no significant change occurred in the control group. Conclusion: Pentoxifylline is effective in improvement of erythropoietin-resistant anemia in ESRD patients.

Anti-inflammatory effect of simvastatin in hemodialysis patients.

BACKGROUND: Patients in the final stages of renal failure have accelerated inflammation conditions. Inflammation causes progressive kidney damage, faster progression of atherogenesis, chronic malnutrition and increased anemia, resulting in lower life expectancy of patients under dialysis. Statins have pleiotropic effects, because the drug has effects more than just decreasing lipids such as antioxidant effects, changes in endothelial dysfunction, stabilizing the plaque and immune system regulator. OBJECTIVES: The aim of the study was to evaluate anti-inflammatory effect of simvastatin (one of the statins) in patients under hemodialysis. PATIENTS AND METHODS: In this clinical trial study, 40 patients under hemodialysis were studied for 12 weeks. Patients were divided into treatment (25 cases) and control groups (15 cases). The treatment group received a daily dosage of 20 mg of simvastatin, while the control group received no medication. The serum amounts of hs-CRP, IL6, Hb and WBC count were measured and compared at baseline and after 12 weeks. In addition, probable hepatic and muscular complications were studied in patients. RESULTS: At baseline, each of treatment and control groups had similar characteristics. During the study, the average level of CRP decreased in the treatment group (P = 0.04), while it was increased in the control group. The amount of serum IL-6 dropped in the treatment group (P = 0.01); however, it was increased in the control group. In both groups, the level of Hb increased significantly at the end of study in the treatment group (P = 0.007) and the control group (P = 0.016). The average WBC count decreased significantly in the treatment group and the control group (P = 0.003). There was no significant change in hepatic and muscular enzymes in the two groups. CONCLUSIONS: End stage renal disease (ESRD) have accelerated inflammatory conditions. Simvastatin clearly lowers the serum levels of CRP and IL-6, and the white blood cell count in dialysis patients. Administering Simvastatin to dialysis patients is safe.

Oral nicotinamide reduces serum phosphorus, increases HDL, and induces thrombocytopenia in hemodialysis patients: a double-blind randomized clinical trial.

BACKGROUND: Recently, nicotinamide has been suggested as an effective drug for hyperphosphatemia in hemodialysis patients. The authors assessed the efficacy and safety of nicotinamide in these patients with lower doses and longer duration than other studies. METHODS: Forty eight patients with fasting serum phosphorus >5 mg/dl enrolled in this randomized clinical trial study and were randomly assigned to two equal-sized groups of nicotinamide or placebo. The study lasted 8 weeks. In the first four weeks, nicotinamide was administered at 500 mg/day, and in the second four weeks at 1,000 mg/day. Blood samples were tested at baseline, week 4, and week 8. RESULTS: In nicotinamide group, the mean phosphorus level decreased from 5.9 ± 0.58 mg/dl to 4.77 ± 1.43 mg/dl in week 4 (P = 0.002) and to 4.66 ± 1.06 mg/dl in week 8 (P = 0.000). The mean calcium-phosphorus product decreased significantly with the same pattern as phosphorus. High-density lipoprotein level increased from 42.46 ± 8.01 mg/dl to 55.71 ± 11.88 mg/dl in week 4 (P = 0.000) and to 65.25 ± 20.18 mg/dl in week 8 (P = 0.000). Levels of serum calcium, uric acid, SGOT, SGPT, and iPTH didn't change significantly. Compared to baseline, the platelet counts were decreased in both week 4 and week 8. No significant changes were observed in placebo group. CONCLUSIONS: In our patients, nicotinamide effectively decreased phosphorus, increased high-density lipoprotein, and caused thrombocytopenia. Since nicotinamide lowered platelet counts and caused thrombocytopenia in lower doses than other studies in these patients, it is necessary to plan other studies for assessing the safety of the drug especially in different populations.