Serological and molecular survey of toxoplasmosis in renal transplant recipients and hemodialysis patients in Kashan and Qom regions, central Iran.

Toxoplasma gondii is one of the important opportunistic pathogen among solid-organ transplant recipients and hemodialysis patients (HD). This study was aimed to detect toxoplasmosis among 50 renal transplant recipients (RTR), 135 HD and 120 healthy individuals in two cities (Kashan and Qom) that located in the center of Iran, from 2014 to 2015. Serological detection (IgG and IgM antibodies) was performed among all individuals in case and control groups. Molecular detection was performed on all IgM positive individuals or IgG positive with moderate to high (>51 IU/mL) antibody titers in HD (n = 42) and control groups (n = 21). In RTR patients, molecular detection was conducted among all seropositive or seronegative individuals (n = 50). IgG seropositivity was detected in 52% (26/50) of RTR, 63% (85/135) of HD and 33.3% (40/120) of the control group. The rate of anti-T. gondii IgG antibody was significantly elevated in RTR and HD patients than the control group (p = 0.023 and p < 0.001, respectively). IgM seropositivity was only detected in one HD patient. T. gondii DNA was detected in 12% (6/50) of RTR and 7.1% (3/42) of HD patients. The results of this study suggested that the screening of toxoplasmosis should be given greater consideration among RTR and hemodialysis patients.

Effect of different doses of folic acid on serum homocysteine level in patients on hemodialysis.

INTRODUCTION: Hyperhomocysteinemia is common in patients with end-stage renal disease. It is one of the risk factors for cardiovascular disease. We evaluated the effect of different doses of folic acid on serum homocysteine level in patients on hemodialysis. MATERIALS AND METHODS: Patients on maintenance hemodialysis were randomized into 4 groups to receive oral folic acid at doses of 2, 5, 10, and 15 mg/d, each for a period of 4 weeks. Serum homocysteine level was measured in all of the patients before and at the end of each week of therapy. Folic acid supplementation was discontinued during a washout period of 1 week between each of the four phases of the trial. RESULTS: Thirty-one hemodialysis patients completed the four phases of treatment with each dose of folic acid (17 women and 14 men). The mean age of patients was 57.6 ± 14.6 years. Serum homocysteine level was reduced significantly compared to its basal level after treatment with folic acid at different doses (P < .001). Different doses of folic acid were not significantly different in lowering serum homocysteine levels. CONCLUSIONS: Our study failed to show any difference between high-dose and low-dose folic acid therapy regarding their effect on serum homocysteine level. It seems folic acid, 2 mg/d, is an adequate dose, and there is no need to administer a higher dose of it.

Effect of hydroxymethylglutaryl-CoA reductase inhibitors on low-density lipoprotein cholesterol, interleukin-6, and high-sensitivity C-reactive protein in end-stage renal disease.

INTRODUCTION. This study was conducted to determine the effect of statins on the serum levels of interleukin-6 (IL-6), low-density lipoprotein cholesterol (LDLC), and high-sensitivity C-reactive protein (HSCPR). MATERIALS AND METHODS. This randomized clinical trial was carried out on 95 hemodialysis patients divided into three groups of atorvastatin, 10 mg; simvastatin, 20 mg; and lovastatin, 40 mg, daily, administered for 2 months. Levels of serum HSCRP, IL-6, and LDLC were all measured before and after the study period. RESULTS. At baseline, 59% of the hemodialysis patients presented with elevated HSCRP, 46.3% them had increased IL-6, and 26.3% had an increased LDLC level. The three drugs were capable to lower the level of HSCRP, among which atorvastatin had the highest effect size (41.8% reduction, P = .001). Lovastatin stood in the next (37.6% reduction, P = .02), while HSCRP reduction was not significant in the simvastatin group (25% reduction, P = .14). Neither of the drugs significantly reduced IL-6 levels. Effects of atorvastatin and simvastatin on the LDLC levels were significant, while lovastatin had a marginal effect. CONCLUSIONS. Use of statins resulted in CRP reduction in patients on hemodialysis. Atorvastatin was much more effective than lovastatin, while CRP reduction was not significant by simvastatin. However, simvastatin had the greatest impact on LDLC. None of these drugs could reduce IL-6 levels within 2 months.