فهرست مطالب behrang alipour abedi

End-stage renal disease (ESRD) is a foremost health issue with major consequences in various parts of the world. In Iran, the prevalence/incidence of ESRD has increased during the past decades. The economic burden of ESRD treatment on patients, their families, and the whole healthcare system is huge as well. Hence ESRD is considered emerging public health problem in developing countries, including Iran, requiring short- and longterm changes in healthcare policies. Developing a national registry system for dialysis patients in Iran now enables us to summarize certain clinical characteristics of these patients and compares the present situation with the late 1990s when dialysis services just began to expand in the country. In this paper, the authors provide information regarding the process of establishing dialysis registry in Iran along with the report of the output of such a registry. Focusing on such an important measure in the whole country of around along with the data that it has produced is a gateway to further progress.

Anemia resistant to erythropoietin stimulating agents (ESAs) is a risk factor for all-cause mortality. Determining the etiologies of hyporesponsiveness may help overcome the resistance. We investigated the contributing factors in a population of hemodialysis patients.
In a multicenter cross-sectional study, from January 2015 to May 2015, point-prevalent hemodialysis patients from 22 dialysis centers in Tehran, Iran, were enrolled. Demographic, clinical, and laboratory data and drug history were recorded. ESA hyporesponsiveness index (EHRI) was calculated by dividing weekly ESA dose per kilogram of body weight (IU/Kg/W) by hemoglobin level (g/dL). Patients with EHRI ≥ 16.49 (4th quartile) were compared with those with EHRI A total of 1224 patients were enrolled among whom, 306 (25%) had an EHRI ≥ 16.49 with a mean hemoglobin level of 9.8 ± 1.4 g/dL. There was no age, gender, or dialysis vintage difference within the groups. Iron status, parathormone, CRP, and diabetes were also similar. Hyporesponsive patients had lower body mass index (BMI) and lower serum albumin (P Apart from the most validated parameters responsible for ESA hyporesponsiveness (e.g. Iron deficiency, dialysis inadequacy, and poorly controlled serum phosphate level), other potential risk factors such as treatment with ACEi/ARB should be evaluated. Discontinuation of these drugs might be a therapeutic strategy to overcome ESA resistance.

Introduction. Both anemia and high doses of erythropoietin have been associated with increased mortality among dialysis patients. This study was conducted to evaluate the effective dose of erythropoiesis-stimulating agents.
Materials and Methods. This multicenter nationwide cross-sectional study assessed adult patients on hemodialysis for at least 3 months from 80 hemodialysis centers in Iran. Demographic data, erythropoietin dose, and laboratory data were collected.
Results. A total of 7009 prevalent hemodialysis patients were enrolled. Fifty-five percent of the patients had their hemoglobin levels within the target values. In those with a hemoglobin level of 8 g/dL to 10 g/dL, an erythropoietin dose of 10000 IU/wk to 12000 IU/wk led to a significant increase in hemoglobin level. A mean erythropoietin dose of 7700 IU/wk was effective in maintaining the target hemoglobin of 10 g/dL to 12 g/dL during a 3-month follow-up period. Improvement in hemoglobin level was associated with male sex, diabetes mellitus, and hemodialysis adequacy, and its deterioration with lower parathyroid hormone, calcium-phosphorus product, and creatinine levels; malnutrition; transfusion; and angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (R2 = 29.1%, P Conclusions. Data suggested that an estimated erythropoietin dose of 66.5 IU/kg/wk for each 1 g/dL hemoglobin level below the target could be used as a guide for prescription. A dosage of about 8000 IU/wk could help maintaining hemoglobin within the target. A longitudinal study is needed to estimate the required erythropoietin dose.

Adequate dialysis improves patients’ outcome. Single pool Kt/V (spKt/V) > 1.4 is recommended as an index of adequacy. In this study, we assessed dialysis adequacy, the etiologies of under dialysis and the solutions..
In a multicenter nationwide cross-sectional study, 7,009 point-prevalent hemodialysis patients were evaluated for dialysis adequacy, blood flow rate (BFR), total body water (V), and the required dialyzer KoA..
The mean age was 57.2 ± 14.9 years. About 90% of the patients were dialyzed 12 hours per week, but only 27.4% had spKt/V > 1.4. The mean BFR was 297.58 ± 28.6 cc/min (4.66 ± 0.84 cc/min/kg). The mean KoA was 787.28 ± 137.19 cc/min. Those with spKt/V > 1.4 had smaller body size and higher BFR. To achieve spKt/V of 1.4, 79.3% of the patients required dialyzer, with KoA of 700 cc/min or more with an average BFR of 400 cc/min. Of the patients, 17.8% had to use either higher BFR (≥ 400 cc/min) and KoA (≥ 1400 cc/min), or be dialyzed for at least four sessions per week, the latter seemed more feasible..
Low BFR and inappropriate dialyzer choice were the leading causes of inadequate dialysis. With respect to attaining the most adequate dialysis based on solute removal, it seems reasonable to evaluate the causes of low BFR and access dysfunction. Better nursing education and decreasing catheter use may help overcome the barriers..

Sirolimus is the one of new immunosuppressants that may be a substitute to traditional drugs such as cyclosporine. We present our investigation on sirolimus-based immunosuppression in kidney transplant recipients as compared with cyclosporine-based immunosuppression. We enrolled 100 patients in an open-labeled randomized clinical trial at Shahid Labbafinejad Medical Center. The patients were assigned to one of the immunosuppressive groups to receive either sirolimus or cyclosporine in combination with mycophenolate mofetil and steroids. All kidney transplant recipients were followed up by for serum creatinine and glomerular filtration rate for 4 years. There was no significant differences between the two groups regarding serum creatinine level and GFR until for years posttransplant; however، serum creatinine levels were significantly lower and the GFRs were higher in the sirolimus group after 3 and 4 years. The mean serum creatinine was 1. 24 ± 0. 28 mg/dL in the sirolimus group and 1. 57 ± 0. 33 mg/dL in the cyclosporine group at 4 years posttransplant (P =. 02). Also، GFR was 79. 8 ± 22. 3 mL/min/1. 73 m2 in the sirolimus group and 70. 3 ± 23. 6 mL/min/1. 73 m2 in the cyclosporine group B (P =. 04). Acute rejection was 1. 7-fold higher in the cyclosporine group than in the sirolimus group. Our study demonstrated that sirolimus in the immunosuppressive regimen of kidney transplant recipients had better outcomes regarding graft and patient survival. The effectiveness of sirolimus for kidney allograft recipients should be further assessed to be implemented from the first day after transplantation.

Introduction. Kidney transplant recipients are at increased risk of cancers, most frequently skin cancers, and in some regions, Kaposi sarcoma and non-Hodgkin lymphoma. We sought to investigate the associate of the most frequent malignancies among our patients with human leukocyte antigens (HLAs). Materials and Methods. We performed a retrospective study on 44 kidney allograft recipients who had posttransplant malignancy and 44 kidney allograft recipients without malignant lesions (control group). All of the patients had been treated by immunosuppressive regimens including cyclosporine plus prednisolone or cyclosporine, prednisolone, and mycophenolate mofetil. Data on HLA typing were achieved from their transplant records. Results. There were 15 patients (34.1%) with Kaposi sarcoma; 13 (29.6%) with non-Hodgkin lymphoma, 6 (13.6%) with skin cancer, 2 (4.5%) with ovary cyst adenocarcinoma, and 8 (18.2%) with other tumors. The mean interval from transplantation to diagnosis of malignancy was 15.3 month. Twelve patients died of cancer during the follow-up (mean, 12.3 years). No significant difference was noted in the age, sex, and time of transplantation between these patients and those in the control group. Kaposi sarcoma was associated with HLA-CW4 (P =. 03) with an odds ratio of 4.96 (95% confidence interval, 2.90 to 8.12). Conclusions. We found HLA-CW4 as a risk factor of Kaposi sarcoma in kidney allograft recipients. Screening for malignancies after kidney transplantation sounds very important with special attention to the specific environmental and genetic factors in each populatio